Provider Demographics
NPI:1023410941
Name:BERTRAM D KAPLAN MD PLLC
Entity type:Organization
Organization Name:BERTRAM D KAPLAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-735-6430
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-1089
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183328Medicaid
AR101969002Medicaid
AR101969002Medicaid
TN3183328Medicaid