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General NPI Number Information
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NPI Number | 1215986823
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Entity Type | Individual
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Provider Name | GENNADY VERTKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 750 12TH AVE BAYLOR SURGICAL HOSPITAL FORT WORTH
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-334-5050
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Fax | 817-334-0235
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Provider Business Mailing Address
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Address Line | 301 NW 82ND AVE
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City | PLANTATION
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State | FL
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Zip | 33324-1811
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Country | US
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Telephone | 954-693-8600
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Fax | 954-452-2693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | M2854
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME48681
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License Number State | FL
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