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NPI Code Detail

MEDICARE: DR. JOAN LOUISE BERGSTROM M.D.

MEDICARE: DR. JOAN LOUISE BERGSTROM M.D.
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
1207VG0400XGynecology PhysicianG8579TX
2174400000XSpecialistG8579TX

General Provider Information

NPI Number : 1396727814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOAN LOUISE BERGSTROM M.D.
Provider Business Mailing Address
First Line : 1001 N WALDROP DR
Second Line : #505
City : ARLINGTON
State : TX
Zip : 76012-4705
Country : US
Telephone Number : 817-277-9415
Fax Number : 817-277-0360
Provider Business Practice Location Address
First Line : 1001 N WALDROP DR
Second Line : #505
City : ARLINGTON
State : TX
Zip : 76012-4705
Country : US
Telephone Number : 817-277-9415
Fax Number : 817-277-0360
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 03/16/2020

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Directions to “ DR. JOAN LOUISE BERGSTROM M.D.” Practice Location

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