Provider Demographics
NPI:1134169741
Name:MOELLER-BERTRAM, TOBIAS (MD)
Entity type:Individual
Prefix:DR
First Name:TOBIAS
Middle Name:
Last Name:MOELLER-BERTRAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44630 MONTEREY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3326
Mailing Address - Country:US
Mailing Address - Phone:800-285-3755
Mailing Address - Fax:
Practice Address - Street 1:36101 BOB HOPE DR STE A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2001
Practice Address - Country:US
Practice Address - Phone:760-321-1315
Practice Address - Fax:760-321-1094
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80383207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I49789Medicare UPIN
CAWA80383BMedicare ID - Type Unspecified
CAWA80383AMedicare ID - Type Unspecified