Provider Demographics
NPI:1194784918
Name:BERGLUND, JAMES ALAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALAN
Last Name:BERGLUND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:ALAN
Other - Last Name:BERGLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2530 25TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5078
Mailing Address - Country:US
Mailing Address - Phone:701-232-9599
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-232-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant