Individual
ROBERT L. BERTRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
92 JOE T PETTY DR, RUSSELL SPRINGS, KY 42642-8543
(270) 866-8881
(270) 866-8849
Mailing address
92 JOE T PETTY DR, SUITE 400, RUSSELL SPRINGS, KY 42642-8544
(270) 866-8881
(270) 866-8849
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02506
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000064586
ANTHEM
KY
01
—
110185245
RAILROAD MEDICARE
KY
01
—
608475500
BLACK LUNG
KY
05
—
64025067
—
KY
Enumeration date
01/15/2007
Last updated
06/05/2015
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