Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10448 | FL |
NPI | 1003904715 |
---|---|
Provider Name | Dr. Robert Overton Bersot |
First Address | Tampa, FL 33613-3905 |
Second Address | Tampa, FL 33613-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |