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General NPI Number Information
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NPI Number | 1407990120
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Entity Type | Individual
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Provider Name | PHYLLIS ANN BERGERON M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 1375 E 19TH AVE
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City | DENVER
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State | CO
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Zip | 80218-1114
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Country | US
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Telephone | 303-812-3600
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Fax | 303-812-4223
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Provider Business Mailing Address
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Address Line | 3069 FOX SEDGE PL
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-7595
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Country | US
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Telephone | 303-263-7035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 30486
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License Number State | CO
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