Healthcare Provider Details

I. General information

NPI: 1730157678
Provider Name (Legal Business Name): ERNEST GEORGE BERTHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CORAL HILLS DR
CORAL SPRINGS FL
33065-4108
US

IV. Provider business mailing address

3114 CROASDAILE DR SUITE 200
DURHAM NC
27705-2508
US

V. Phone/Fax

Practice location:
  • Phone: 954-344-3100
  • Fax: 919-425-0478
Mailing address:
  • Phone: 877-751-1157
  • Fax: 919-425-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME97151
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME97151
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME97151
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME97151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: