Provider Demographics
NPI:1083639462
Name:BERGERON, DENIS EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:EUGENE
Last Name:BERGERON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 PLAINVIEW ST
Mailing Address - Street 2:#1
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1989
Mailing Address - Country:US
Mailing Address - Phone:713-947-8837
Mailing Address - Fax:713-947-1195
Practice Address - Street 1:3325 PLAINVIEW ST
Practice Address - Street 2:#1
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1989
Practice Address - Country:US
Practice Address - Phone:713-947-8837
Practice Address - Fax:713-947-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034265101Medicaid
TXJT74Medicare ID - Type Unspecified
TX034265101Medicaid