Provider Demographics
NPI:1992859805
Name:BERGMAN, STUART M (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:M
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:625 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2155
Practice Address - Country:US
Practice Address - Phone:602-406-8222
Practice Address - Fax:602-406-7811
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ74839208800000X
IDM-15122208800000X
PAMD465614208800000X
FLME100410208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL325061OtherAVMED
PA103625804Medicaid
10381145OtherCAQH
FL47450OtherBCBS OF FL
FLP110118OtherFREEDOM HEALTH
FL000256000Medicaid
FL10H686OtherHEALTHY KIDS
FL1192907OtherWELLCARE
FL5248030OtherAETNA
VA7595816Medicaid
FL8533707OtherCIGNA
FLP01195011OtherRAILROAD MCR
NC2292290 AOtherPIEDMONT STONE CENTER PHY
VA7595816Medicaid
FLP00645720Medicare PIN
FL47450OtherBCBS OF FL
FL000256000Medicaid