Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR.0022982 | CO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 22982 | CO |
NPI | 1053392282 |
---|---|
Provider Name | Dr. Roger P Bermingham |
First Address | Fort Collins, CO 80524-3257 |
Second Address | Fort Collins, CO 80524-3257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2005 |
Last Update Date | 12/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01229822 | (05) | CO |
D24187 | (02) | CO |
P01135769 | RAILROAD MEDICARE (01) | CO |