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General NPI Number Information
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NPI Number | 1417906561
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Entity Type | Organization
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Legal Business Name | PREMIERE PERINATAL ASSOCIATES
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 200 NW 7TH AVE PREMIERE PERINATAL ASSOCIATES
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-9026
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Country | US
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Telephone | 954-759-6789
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Fax | 919-425-0478
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Provider Business Mailing Address
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Address Line | 500 SE 17TH ST SUITE 100
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-2547
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Country | US
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Telephone | 919-425-1565
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Fax | 919-425-0478
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. BERTRAM WALLS
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Credential | MD
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | ME43546
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License Number State | FL
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