Provider Demographics
NPI:1396138608
Name:KEY BISCAYNE PEDIATRICS, P.A . / JORGE L. BERTRAN, MD.
Entity type:Organization
Organization Name:KEY BISCAYNE PEDIATRICS, P.A . / JORGE L. BERTRAN, MD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BERTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-361-7979
Mailing Address - Street 1:604 CRANDON BOULEVARD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149
Mailing Address - Country:US
Mailing Address - Phone:305-361-7979
Mailing Address - Fax:305-361-6019
Practice Address - Street 1:604 CRANDON BOULEVARD
Practice Address - Street 2:SUITE 202
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149
Practice Address - Country:US
Practice Address - Phone:305-361-7979
Practice Address - Fax:305-361-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty