Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 30486 | CO |
NPI | 1407990120 |
---|---|
Provider Name | Dr. Phyllis Ann Bergeron |
First Address | Highlands Ranch, CO 80126-7595 |
Second Address | Denver, CO 80218-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006041 | KAISER-COMMERCIAL NUMBER (01) | CO |
01304864 | (05) | CO |
D83659 | (02) | CO |