Provider Demographics
NPI:1407875776
Name:BERGMAN, GARY DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DUANE
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2979 SQUALICUM PKWY
Mailing Address - Street 2:SUITE #203
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1811
Mailing Address - Country:US
Mailing Address - Phone:360-733-7670
Mailing Address - Fax:360-647-1901
Practice Address - Street 1:2979 SQUALICUM PKWY
Practice Address - Street 2:SUITE #203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-733-7670
Practice Address - Fax:360-647-1901
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00020196207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB23290Medicare PIN
WAA53344Medicare UPIN