Provider Demographics
NPI:1770094153
Name:BERGREN, THOMAS M (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:BERGREN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3131 LA CANADA ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-369-5582
Practice Address - Fax:702-650-5148
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2023-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101023688207R00000X
NVDO2846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770094153Medicaid
NVDO2846OtherSTATE LICENSE