Provider Demographics
NPI:1942286968
Name:BERGMAN, BRADLEY DAVID (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVID
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 WESTOWN PKWY STE 236
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6720
Mailing Address - Country:US
Mailing Address - Phone:515-401-1950
Mailing Address - Fax:515-401-1955
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:152-416-3725
Practice Address - Fax:515-401-1955
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2024-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA03495207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03495OtherTRICARE PROVIDER #
IA35261OtherBLUE SHIELD PROVIDER #
IAP00050806OtherRAILROAD MEDICARE #
IAIA0100OtherJOHN DEERE PROVIDER #
IA239843OtherMIDLANDS PROVIDER #
IA0416420Medicaid
IA03495OtherTRICARE PROVIDER #
IA35261OtherBLUE SHIELD PROVIDER #