Provider Demographics
NPI:1427047158
Name:WALLS, BERTRAM E (MD)
Entity type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:E
Last Name:WALLS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1600 S. ANDREWS AVENUE
Mailing Address - Street 2:SUITE 323 WEST WING
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-355-5110
Mailing Address - Fax:954-355-4919
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:PHOENIX OBSTETRICS/GYNECOLOGY, LLC
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:954-355-4919
Is Sole Proprietor?:No
Enumeration Date:2005-10-15
Last Update Date:2015-06-26
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Provider Licenses
StateLicense IDTaxonomies
FLME43546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C86981Medicare UPIN