MEDICARE: MR. ROBERT J BERTOT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9104718	FL

General Provider Information

NPI Number	:	1124096946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J BERTOT PA-C

Provider Business Mailing Address
First Line	:	10535 NW 43RD TER
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-2265
Country	:	US
Telephone Number	:	786-514-8893
Fax Number	:

Provider Business Practice Location Address
First Line	:	14150 SW 136TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-5506
Country	:	US
Telephone Number	:	786-888-8820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/26/2025

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