Provider Demographics
NPI:1861464711
Name:BERGEY, DARREN L (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:L
Last Name:BERGEY
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 1:900 E WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-7111
Mailing Address - Country:US
Mailing Address - Phone:909-824-2422
Mailing Address - Fax:909-824-8234
Practice Address - Street 1:1040 S MOUNT VERNON AVE
Practice Address - Street 2:#G350
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4228
Practice Address - Country:US
Practice Address - Phone:909-824-2422
Practice Address - Fax:909-824-8234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53228Medicare UPIN