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NPI Code Detail

MEDICARE: DR. BRADLEY ALAN BERTRAM M.D.

MEDICARE: DR. BRADLEY ALAN BERTRAM M.D.
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
1207W00000XOphthalmology Physician030011GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11977325OTHERCIGNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
318BDFMJOTHERGAPTAN
44363115OTHERAETNA
5768090OTHERGABLUE CROSS OF GEORGIA

General Provider Information

NPI Number : 1184785008
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY ALAN BERTRAM M.D.
Provider Business Mailing Address
First Line : 1330 INTERSTATE PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-5625
Country : US
Telephone Number : 706-651-2020
Fax Number : 706-855-6674
Provider Business Practice Location Address
First Line : 1330 INTERSTATE PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-5625
Country : US
Telephone Number : 706-651-2020
Fax Number : 706-855-6674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 05/28/2015

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