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NPI Code Detail

MEDICARE: BRADLEY WERTMAN M.D.

MEDICARE: BRADLEY WERTMAN 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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianE1175TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2220018813OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1220031573OTHERTXRAILROAD M/C-HPA1

General Provider Information

NPI Number : 1609871672
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY WERTMAN M.D.
Provider Business Mailing Address
First Line : PO BOX 420995
Second Line :
City : HOUSTON
State : TX
Zip : 77242-0995
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7600 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77054-1906
Country : US
Telephone Number : 713-481-3540
Fax Number : 713-432-0221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 03/19/2009

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