Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 36050 | CO |
N | 207VG0400X | Gynecologist | 36050 | CO |
NPI | 1174506422 |
---|---|
Provider Name | Dr. Roy G Bergstrom |
First Address | Highlands Ranch, CO 80129-2251 |
Second Address | Littleton, CO 80122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11132833 | (05) | CO |
H55912 | (02) |