Healthcare Provider Details

I. General information

NPI: 1447250964
Provider Name (Legal Business Name): JOSE BERTHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST STE 111
CORAL SPRINGS FL
33065-4000
US

IV. Provider business mailing address

9750 NW 33RD ST STE 111
CORAL SPRINGS FL
33065-4000
US

V. Phone/Fax

Practice location:
  • Phone: 954-368-9656
  • Fax: 954-368-9356
Mailing address:
  • Phone: 954-368-9656
  • Fax: 954-368-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME87574
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number87574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: