Provider Demographics
NPI:1417929696
Name:BERGLUND, LARS F (MD PHD)
Entity Type:Individual
Prefix:
First Name:LARS
Middle Name:F
Last Name:BERGLUND
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2604 ROCKWELL DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-7664
Mailing Address - Country:US
Mailing Address - Phone:916-703-9120
Mailing Address - Fax:916-703-9124
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE G400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-703-9120
Practice Address - Fax:916-703-9124
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAF005002207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA8542Medicare UPIN