Provider Demographics
NPI:1255380754
Name:BERGANT, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:BERGANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7611 STATE LINE RD
Mailing Address - Street 2:STE240
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-6801
Mailing Address - Country:US
Mailing Address - Phone:816-363-1155
Mailing Address - Fax:816-363-1149
Practice Address - Street 1:7611 STATE LINE RD
Practice Address - Street 2:STE240
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-6801
Practice Address - Country:US
Practice Address - Phone:816-363-1155
Practice Address - Fax:816-363-1149
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0414406208800000X
MO105379208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
18853091OtherBCBS
340016718OtherRAILROAD MEDICARE
KS100139280BMedicaid
KSJ713853Medicare PIN
KS100139280BMedicaid