Individual
PHILLIP D BERTRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
438 N WHITNEY AVE, COOKEVILLE, TN 38501-2455
(931) 783-2616
(931) 783-2610
Mailing address
140 W 7TH ST, COOKEVILLE, TN 38501-1726
(931) 783-5582
(931) 526-6760
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
6496
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3154324
—
TN
01
—
4212762
BCBS
TN
05
—
64790702
—
KY
Enumeration date
09/02/2005
Last updated
05/26/2022
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