CARMEN RENEE BERGOM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

ACTIVE

Business

Title

First Name

CARMEN

Middle

RENEE

Last Name

BERGOM

Business Name

CARMEN RENEE BERGOM MD

Original Issue Date

07/13/2020

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

OKAUCHEE

State

Zip

53069

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023