Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 34-003103 | OH |
NPI | 1063410611 |
---|---|
Provider Name | Dr. Anthony Patrick Bertin |
First Address | Canton, OH 44708-5057 |
Second Address | Canton, OH 44708-5057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0504592 | (05) | OH |
A80494 | (02) |