Provider Demographics
NPI:1104828003
Name:TAGERT, BERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:E
Last Name:TAGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 300 E
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:423-844-6450
Mailing Address - Fax:423-844-6499
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:STE 300 E
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6450
Practice Address - Fax:423-844-6499
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19394207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006404804Medicaid
TN3064402Medicaid
VA006404804Medicaid
TN200025546Medicare PIN
TN3064402Medicaid