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General NPI Number Information
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NPI Number | 1508285909
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Entity Type | Individual
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Provider Name | JAMES DAVID BERGENE MD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 55 LOCK ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-3603
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Country | US
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Telephone | 203-688-8242
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | TORRINGTON
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State | WY
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Zip | 82240-0550
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Country | US
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Telephone | 307-630-1665
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DR.0067337
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD61311598
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 11718A
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 79105
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License Number State | CT
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