Provider Demographics
NPI:1699920496
Name:BERGMAN, STEVEN PAUL (LAT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BOUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1002
Mailing Address - Country:US
Mailing Address - Phone:817-683-4251
Mailing Address - Fax:817-306-4116
Practice Address - Street 1:10 BOUNTY RD E
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-1002
Practice Address - Country:US
Practice Address - Phone:817-683-4251
Practice Address - Fax:817-306-4116
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT2988171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor