MEDICARE: MOELLER-BERTRAM MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208VP0014X	Interventional Pain Medicine Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
4	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1699586388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOELLER-BERTRAM MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	44630 MONTEREY AVE STE 100
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36101 BOB HOPE DR STE A1
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2002
Country	:	US
Telephone Number	:	760-321-1315
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TOBIAS MOELLER-BERTRAM
Credential	:	MD
Telephone Number	:	800-285-3755

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	03/02/2025

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