Provider Demographics
NPI:1548238348
Name:KAPLAN, BERTRAM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:DAVID
Last Name:KAPLAN
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 1:200 S RHODES ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4212
Mailing Address - Country:US
Mailing Address - Phone:870-735-6430
Mailing Address - Fax:870-735-6432
Practice Address - Street 1:200 S RHODES ST
Practice Address - Street 2:SUITE G
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4212
Practice Address - Country:US
Practice Address - Phone:870-735-6430
Practice Address - Fax:870-735-6432
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11193207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183328Medicaid
TN3183328Medicare PIN
TNB04074Medicare UPIN
TN3183328Medicaid