Healthcare Provider Details

I. General information

NPI: 1699744482
Provider Name (Legal Business Name): GREGORY EMILE BERTUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/25/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BERTUCCI BLVD
BILOXI MS
39531-2255
US

IV. Provider business mailing address

431 BERTUCCI BLVD
BILOXI MS
39531-2255
US

V. Phone/Fax

Practice location:
  • Phone: 228-385-2020
  • Fax: 228-388-9435
Mailing address:
  • Phone: 228-385-2020
  • Fax: 228-388-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number08302
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: