Provider Demographics
NPI:1629343702
Name:ANN MARIE BERTLES MD PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ANN MARIE BERTLES MD PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-437-9690
Mailing Address - Street 1:23232 KINGSLAND BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2985
Mailing Address - Country:US
Mailing Address - Phone:832-437-9690
Mailing Address - Fax:832-437-9694
Practice Address - Street 1:23232 KINGSLAND BLVD STE E
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2985
Practice Address - Country:US
Practice Address - Phone:832-437-9690
Practice Address - Fax:832-437-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBS OF TXOther0032XQ
TXBCBS OF TXOther0032XQ