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General NPI Number Information
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NPI Number | 1942316450
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Entity Type | Individual
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Provider Name | BRYAN BERTUCCI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 843 MILLING AVE
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City | LULING
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State | LA
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Zip | 70070-4442
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Country | US
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Telephone | 985-785-5851
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Fax | 504-278-4692
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Provider Business Mailing Address
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Address Line | 7718 W JUDGE PEREZ DR
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City | ARABI
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State | LA
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Zip | 70032-1919
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Country | US
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Telephone | 504-271-8952
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Fax | 504-278-4692
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 015628
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License Number State | LA
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