Provider Demographics
NPI:1760440267
Name:JANNE D'OTHEE, BERTRAND (MD)
Entity Type:Individual
Prefix:PROF
First Name:BERTRAND
Middle Name:
Last Name:JANNE D'OTHEE
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 1:71780 SAN JACINTO DR BLDG I
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:760-568-3461
Mailing Address - Fax:760-423-6273
Practice Address - Street 1:3333 CONCOURS STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4875
Practice Address - Country:US
Practice Address - Phone:909-481-3242
Practice Address - Fax:909-481-3243
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-349362085R0202X
NMMD2014-07612085R0204X
MN587822085R0204X
MEMD183492085R0204X
MA2188472085R0204X
CAC530602085R0202X
ZZFRANCE2085R0202X, 2085R0202X
ZZBELGIUM2085R0202X
MDD690872085R0202X
NH168272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology