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General NPI Number Information
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NPI Number | 1396138608
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Entity Type | Organization
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Legal Business Name | KEY BISCAYNE PEDIATRICS, P.A . / JORGE L. BERTRAN, MD.
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 604 CRANDON BOULEVARD SUITE 202
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City | KEY BISCAYNE
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State | FL
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Zip | 33149
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Country | US
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Telephone | 305-361-7979
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Fax | 305-361-6019
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Provider Business Mailing Address
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Address Line | 604 CRANDON BOULEVARD SUITE 202
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City | KEY BISCAYNE
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State | FL
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Zip | 33149
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Country | US
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Telephone | 305-361-7979
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Fax | 305-361-6019
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Authorized Official
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Title or Position | MD
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Name | MR. JORGE LUIS BERTRAN
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Credential | MD
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Telephone | 305-361-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME53162
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License Number State | FL
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