Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 017640 | LA |
NPI | 1033183769 |
---|---|
Provider Name | Dr. Charles Cole Berggreen |
First Address | Baton Rouge, LA 70809-2440 |
Second Address | Baton Rouge, LA 70809-2440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 07/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1349623 | (05) | LA |
B64174 | (02) | LA |