Provider Demographics
NPI:1598860405
Name:BERGES, RONALD RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAY
Last Name:BERGES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6416
Mailing Address - Country:US
Mailing Address - Phone:641-684-7744
Mailing Address - Fax:
Practice Address - Street 1:1112 N VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6416
Practice Address - Country:US
Practice Address - Phone:641-684-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13049962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14660OtherINDIVIDUAL PROVIDER #
IA43269OtherINDIVIDUAL PROVIDER #
IA2776088Medicaid
IA421525352-01OtherINDIVIDUAL PROVIDER #
IA421525352-01OtherINDIVIDUAL PROVIDER #
IAI5082Medicare ID - Type Unspecified