Provider Demographics
NPI:1790217149
Name:BERGERON, JEFFREY MARK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:BERGERON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER RD STE 310
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:305-807-8284
Practice Address - Street 1:10970 SHADOW CREEK PKWY STE 360
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0123
Practice Address - Country:US
Practice Address - Phone:713-436-8071
Practice Address - Fax:866-939-1568
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA328608208D00000X
390200000X
TXT8489207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program