Provider Demographics
NPI:1336134030
Name:BERGERON, LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:BERGERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2710
Mailing Address - Country:US
Mailing Address - Phone:775-738-2034
Mailing Address - Fax:775-738-3241
Practice Address - Street 1:160 12TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4002
Practice Address - Country:US
Practice Address - Phone:775-738-2034
Practice Address - Fax:775-738-3241
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5959208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69664Medicare UPIN
NVE69664Medicare UPIN
WMBQS02Medicare PIN