Provider Demographics
NPI:1124020805
Name:BERGMAN, RONALD STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEVEN
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4920
Mailing Address - Country:US
Mailing Address - Phone:515-222-1111
Mailing Address - Fax:515-244-9914
Practice Address - Street 1:2000 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4920
Practice Address - Country:US
Practice Address - Phone:515-222-1111
Practice Address - Fax:515-244-9914
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01839208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2178665Medicaid
IA42-1494956OtherIRS INDIVIDUAL TIN
IA42-1494956OtherIRS INDIVIDUAL TIN
IA2178665Medicaid