Provider Demographics
NPI:1780652537
Name:ROBERT J & BERTRAM D KAPLAN MDS PA
Entity Type:Organization
Organization Name:ROBERT J & BERTRAM D KAPLAN MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-682-3273
Mailing Address - Street 1:6401 POPLAR AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4823
Mailing Address - Country:US
Mailing Address - Phone:901-682-3273
Mailing Address - Fax:901-682-6559
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:901-735-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183328Medicaid
TN3162895Medicaid
AR101969002Medicaid
TN3183328Medicaid
AR101969002Medicaid
AR57119Medicare PIN
TNB02971Medicare UPIN
TN3162895Medicare PIN