Provider Demographics
NPI:1023097847
Name:BERGMAN, LYNN (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5633 N LIDGERWOOD
Mailing Address - Street 2:EMERGENCY PHYSICIANS SERVICES
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-482-2448
Mailing Address - Fax:509-482-2452
Practice Address - Street 1:5633 N LIDGERWOOD
Practice Address - Street 2:EMERGENCY PHYSICIANS SERVICES
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-482-2448
Practice Address - Fax:509-482-2452
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041950207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000362000OtherMEDICARE GROUP
WA8463721Medicaid
WA8463721Medicaid