Provider Demographics
NPI:1679764856
Name:BERGERON, BRANDY MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:MICHELLE
Last Name:BERGERON
Suffix:
Gender:F
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:PO BOX 5887
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-5887
Mailing Address - Country:US
Mailing Address - Phone:409-838-5214
Mailing Address - Fax:
Practice Address - Street 1:755 N 11TH ST STE P3600
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1515
Practice Address - Country:US
Practice Address - Phone:409-838-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8761207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4660460297OtherMYUTMB 4660460297