Provider Demographics
NPI:1629055470
Name:BERGMAN, JAMES JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JAY
Last Name:BERGMAN
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 1:11304 ELK HORN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9568
Mailing Address - Country:US
Mailing Address - Phone:515-961-7023
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-5722
Practice Address - Fax:515-241-4403
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17916207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0073395Medicaid
IA17916OtherTRICARE PROVIDER #
IAIA0112OtherJOHN DEERE PROVIDER #
IA07339OtherBLUE SHIELD PROVIDER #
IA4278OtherMIDLANDS PROVIDER #
IA0073395Medicaid
IA07339OtherBLUE SHIELD PROVIDER #