MEDICARE: JACK M. BERTMAN 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
1	207P00000X	Emergency Medicine Physician	G33641	CA

General Provider Information

NPI Number	:	1891777967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK M. BERTMAN M.D.

Provider Business Mailing Address
First Line	:	845 JACKSON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4851
Country	:	US
Telephone Number	:	775-790-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 JACKSON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4851
Country	:	US
Telephone Number	:	775-790-0463
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/09/2007

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