Healthcare Provider Details

I. General information

NPI: 1396138608
Provider Name (Legal Business Name): KEY BISCAYNE PEDIATRICS, P.A . / JORGE L. BERTRAN, MD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CRANDON BOULEVARD SUITE 202
KEY BISCAYNE FL
33149
US

IV. Provider business mailing address

604 CRANDON BOULEVARD SUITE 202
KEY BISCAYNE FL
33149
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-7979
  • Fax: 305-361-6019
Mailing address:
  • Phone: 305-361-7979
  • Fax: 305-361-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME53162
License Number StateFL

VIII. Authorized Official

Name: MR. JORGE LUIS BERTRAN
Title or Position: MD
Credential: MD
Phone: 305-361-7979