Provider Demographics
NPI:1336318377
Name:BRYON L. BERGE, D.O., P.C.
Entity Type:Organization
Organization Name:BRYON L. BERGE, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-859-5755
Mailing Address - Street 1:1780 WASHINGTON ST
Mailing Address - Street 2:#303
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9101 HARLAN ST
Practice Address - Street 2:306
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2924
Practice Address - Country:US
Practice Address - Phone:303-425-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285765842OtherNPI-TYPE 1
I21145Medicare UPIN