Robert W Bergstrom, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD24029 Issued in OR

Practice address

831 NW Council Dr
Suite 125
Gresham, OR 97030-3721

Phone

(503) 661-3439

Fax

(503) 669-1360

NPI assigned

Apr 21, 2006

Last updated

Mar 17, 2010By the provider in NPPES

Sex

Male

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

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268784000000",
    "number": "1982660700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92900",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972920900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR",
            "address_2": "SUITE 125",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303721",
            "telephone_number": "503-661-3439",
            "fax_number": "503-669-1360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "ROBERT",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2010-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD24029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8372849",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286638",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Gail Bennett
• Sandra J. Bennett, DMD
• Ramon Benton, MSW, CSWA
• Amy E Berg, PMHNP
• Daniel R Berger
• Lily Bradenrose Berlstein, SLP
• Heidi Bermeosolo, LPC
• Gabriel Tucker Bertell, PHARMD
• Mark Anthony Betsill, D.C
• Athena Marie Bettger, DMD

• Internal Medicine Physician in Gresham, OR
• Providers in Gresham, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.