Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 87574 | FL |
N | 207VX0000X | Obstetrician | ME87574 | FL |
NPI | 1447250964 |
---|---|
Provider Name | Jose Berthe |
First Address | Coral Springs, FL 33065-4000 |
Second Address | Coral Springs, FL 33065-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267205700 | (05) | FL |
49081 | BLUE CROSS BLUE SHIELD (01) | |
H05734 | (02) |