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1497721195
LARS BERGESON
PROVIDENCE, UT
NPI
1497721195
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: UT 170371-1205)
Enumeration Date
2006-02-23
Last Update Date
2009-11-09
Business Address
Dr. LARS BERGESON M.D.
382 W 280 N
PROVIDENCE, UT 84332-9707
Phone number: 435-752-0330
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Mailing Address
Dr. LARS BERGESON M.D.
PO BOX 609
PROVIDENCE, UT 84332-0609
Phone number: 435-752-0330
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