Provider Demographics
NPI:1922154285
Name:BERGMAN, RONALD J (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
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 1:243511 W HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9472
Mailing Address - Country:US
Mailing Address - Phone:360-452-6252
Mailing Address - Fax:360-452-6274
Practice Address - Street 1:243511 W HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-9472
Practice Address - Country:US
Practice Address - Phone:360-452-6252
Practice Address - Fax:360-452-6274
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G28131Medicare UPIN