Provider Demographics
NPI:1568586014
Name:BERGEAUX, SCOTT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAMES
Last Name:BERGEAUX
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 1:707 N MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-2923
Mailing Address - Country:US
Mailing Address - Phone:337-643-6219
Mailing Address - Fax:337-643-6230
Practice Address - Street 1:707 N MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-2923
Practice Address - Country:US
Practice Address - Phone:337-643-6219
Practice Address - Fax:337-643-6230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine