Provider Demographics
NPI:1548238751
Name:BERGMANN, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:BERGMANN
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 1:6 JUNGERMANN CIRCLE
Mailing Address - Street 2:STE 205
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-2122
Mailing Address - Fax:636-441-5290
Practice Address - Street 1:6 JUNGERMANN CIRCLE
Practice Address - Street 2:STE 205
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-441-2122
Practice Address - Fax:636-441-5290
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
25582OtherBLUE CROSS BLUE SHIELD
3086713001SP11526OtherSIGNA
11637OtherESSENCE
MO201292216BEMedicaid
088442OtherGREAT WEST
4061300OtherAETNA
G038OtherPRINCIPAL
STL1700065OtherUNITED HEALTHCARE
100010OtherHEALTHLINK
3554V2907OtherGHP
430910980005OtherPRUDENTIAL
1016224OtherCARE PARTNERS
017022OtherEXLCUSIVE CHOICE
100010OtherHEALTHLINK
25582OtherBLUE CROSS BLUE SHIELD
A10271Medicare UPIN
000002202Medicare ID - Type Unspecified