Provider Demographics
NPI:1164051694
Name:BERGERON, ANDREW JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:BERGERON
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 1:1914 WHITE OAKS ST
Mailing Address - Street 2:
Mailing Address - City:SCHRIEVER
Mailing Address - State:LA
Mailing Address - Zip Code:70395-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1914 WHITE OAKS ST
Practice Address - Street 2:
Practice Address - City:SCHRIEVER
Practice Address - State:LA
Practice Address - Zip Code:70395-3422
Practice Address - Country:US
Practice Address - Phone:985-232-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program