Healthcare Provider Details

I. General information

NPI: 1760452007
Provider Name (Legal Business Name): ALEXANDER JAVIER BERTOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 84TH AVE STE 102
PLANTATION FL
33324-2729
US

IV. Provider business mailing address

220 SW 84TH AVE STE 102
PLANTATION FL
33324-2729
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-1530
  • Fax: 954-720-6540
Mailing address:
  • Phone: 954-349-2345
  • Fax: 954-641-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME88346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: