Dwight a Bergquist MD Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G38711 Issued in CA

Legal business name

DWIGHT A BERGQUIST MD INC

Practice address

5230 N. Clark Avenue
Suite 10
Lakewood, CA 90712-2649

Phone

(562) 804-4428

Fax

(562) 867-5264

NPI assigned

Dec 29, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dwight A Bergquist, M.D.

Title

Ceo

Phone

(562) 804-4428

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370304000000",
    "number": "1003110495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5230 N. CLARK AVENUE",
            "address_2": "SUITE 10",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907122649",
            "telephone_number": "562-804-4428",
            "fax_number": "562-867-5264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 N. CLARK AVENUE",
            "address_2": "SUITE 10",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907122649",
            "telephone_number": "562-804-4428",
            "fax_number": "562-867-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWIGHT A BERGQUIST MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-29",
        "last_updated": "2013-06-04",
        "status": "A",
        "authorized_official_last_name": "BERGQUIST",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-804-4428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G38711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1053407544",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.