=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760452007
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER JAVIER BERTOT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2006
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 SW 84TH AVE STE 102
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-720-1530
-----------------------------------------------------
Fax | 954-720-6540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 SW 84TH AVE STE 102
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-349-2345
-----------------------------------------------------
Fax | 954-641-1080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME88346
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------