Provider Demographics
NPI:1174595912
Name:BERGQUIST, VINCENT F JR (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:F
Last Name:BERGQUIST
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2895
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-2895
Mailing Address - Country:US
Mailing Address - Phone:256-739-5505
Mailing Address - Fax:256-964-9954
Practice Address - Street 1:1938 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-1818
Practice Address - Country:US
Practice Address - Phone:256-739-4030
Practice Address - Fax:256-739-5743
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00417207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000417Medicaid
ALC75130Medicare UPIN
000000417Medicare PIN