Russell Alan Bergum D.O.

NPI 1669400024 - Family Medicine - 207QS0010X

NPI Details
NPI 1669400024
Gender Male
Enumeration Date 06/28/2006
Last Updated 09/09/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
404 W FOUNTAIN ST
ALBERT LEA MN, 56007-2437, US
Phone (507) 373-2384
Fax
Business Location
404 W FOUNTAIN ST
ALBERT LEA MN, 56007-2437, US
Phone (507) 373-2384
Fax
Toxanomy
Taxonomy Code 207QS0010X
License State Minnesota
License Number 42602
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According to our database, Russell Alan Bergum D.O. NPI is 1669400024, taxonomy code is 207QS0010X and license number is 42602, license state is located at Minnesota. Russell Alan Bergum D.O. physically located at 404 W Fountain St, Albert Lea MN, 56007-2437. NPI Number Russell Alan Bergum D.O. has the Individual type.

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1669400024 NPI number is provided on an as is basis without warranty of any kind. 1669400024 is maintained by the National Plan & Provider Enumeration System. The contents of Russell Alan Bergum D.O. are for informational purposes only.