Basic Information
| Provider Information | |||||||||
| NPI: | 1336134030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGERON | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2710 | ||||||||
| Address2: | |||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898032710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757382034 | ||||||||
| FaxNumber: | 7757383241 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 12TH ST | ||||||||
| Address2: | |||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898014002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757382034 | ||||||||
| FaxNumber: | 7757383241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 5959 | NV | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.