MEDICARE: LYNN BERGMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD00041950	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G000362000	OTHER	WA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023097847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN BERGMAN MD

Provider Business Mailing Address
First Line	:	5633 N LIDGERWOOD
Second Line	:	EMERGENCY PHYSICIANS SERVICES
City	:	SPOKANE
State	:	WA
Zip	:	99208
Country	:	US
Telephone Number	:	509-482-2448
Fax Number	:	509-482-2452

Provider Business Practice Location Address
First Line	:	5633 N LIDGERWOOD
Second Line	:	EMERGENCY PHYSICIANS SERVICES
City	:	SPOKANE
State	:	WA
Zip	:	99208
Country	:	US
Telephone Number	:	509-482-2448
Fax Number	:	509-482-2452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	09/18/2020

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