Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25257 | NE |
N | 208600000X | Surgeon | 25257 | NE |
N | 208200000X | Surgeon | A121357 | CA |
N | 208600000X | Surgeon | A121357 | CA |
Y | 208200000X | Surgeon | MD-46200 | IA |
Y | 208600000X | Surgeon | MD-46200 | IA |
N | 2086S0102X | Surgical Critical Care | MD-46200 | IA |
N | 2086S0127X | Trauma Surgeon | 25257 | NE |
N | 2086S0129X | Vascular Surgeon | MD-46200 | IA |
NPI | 1013120740 |
---|---|
Provider Name | Dr. Robert Paul Bertellotti |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 05/07/2019 |