Phyllis Ann Bergeron, M.D.

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

30486 Issued in CO

Practice address

1375 E 19TH Ave
Denver, CO 80218-1114

Phone

(303) 812-3600

Fax

(303) 812-4223

NPI assigned

Feb 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1407990120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3069 FOX SEDGE PL",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801267595",
            "telephone_number": "303-263-7035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 E 19TH AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181114",
            "telephone_number": "303-812-3600",
            "fax_number": "303-812-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "PHYLLIS",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "CO",
            "license": "30486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01304864",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER-COMMERCIAL NUMBER",
            "identifier": "006041",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Constance Ann Bergene, REGISTER NURSE
• Allen R Berger, DC
• Alyssa Berger, FNP
• Kristin Vanderploeg Berger, MD
• Sally C Berger, M.D.
• Cari Lynn Berget, RN
• Carly Ellen Bergey, CCC-SLP
• Alison Bergh
• Stephanie Anne Berghorn, LPC
• Ron Bergloff

• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Denver, CO
• Providers in Denver, CO by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.