Provider Demographics
NPI:1285631937
Name:BERGERON, GENE FRANCIS (NP)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:FRANCIS
Last Name:BERGERON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESTFORK DR
Mailing Address - Street 2:STE 401
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70827-0004
Mailing Address - Country:US
Mailing Address - Phone:337-369-9213
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:225 DUNN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4413
Practice Address - Country:US
Practice Address - Phone:985-876-0300
Practice Address - Fax:985-872-0317
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN082511 - AP03991363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00070569OtherRR MEDICARE
LA1114502Medicaid
LAP61679Medicare UPIN
LA4C2626833Medicare PIN