J BERGERON MD PA NPI 1083809339

NPI Details

J BERGERON MD PA is a clinic center in Houston, TX. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). J BERGERON MD PA NPI is 1083809339. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellcare Clinic.

The provider's business location address is:

1961 W TC JESTER BLVD
HOUSTON, TX
ZIP 77008-256
Phone: (713) 225-9355
Fax: (713) 861-8970

The provider's authorized official is John Bergeron .
The authorized official title is Medical Director/owner and has the following contact phone number (713) 225-9355.

The CLIA number assigned to this NPI record is 45D1080399 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/10/2007 and was last updated on 9/10/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available: