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General NPI Number Information
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NPI Number | 1942598016
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Entity Type | Organization
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Legal Business Name | JACK M BERT MD PA
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 2025 WOODLANE DR
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City | WOODBURY
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State | MN
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Zip | 55125-2987
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Country | US
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Telephone | 651-492-6762
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 WOODLANE DR
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City | WOODBURY
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State | MN
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Zip | 55125-2987
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Country | US
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Telephone | 651-492-6762
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK M BERT
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Credential | MD
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Telephone | 651-491-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 21554
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License Number State | MN
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