Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD10538 | HI |
N | 207RG0300X | Geriatric Medicine | ME77724 | FL |
NPI | 1083664064 |
---|---|
Provider Name | Dr. Jeffrey Aric Bergsman |
First Address | Kailua Kona, HI 96740-2904 |
Second Address | Kailua Kona, HI 96740-2144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |