Provider Demographics
NPI:1356435267
Name:JOHN E. BERTINI, JR., MD, PA
Entity type:Organization
Organization Name:JOHN E. BERTINI, JR., MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTINI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-650-1502
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1502
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8327
Mailing Address - Country:US
Mailing Address - Phone:713-650-1502
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1502
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8327
Practice Address - Country:US
Practice Address - Phone:713-650-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082730501Medicaid
TX00G85PMedicare ID - Type Unspecified