Individual
FRED JEFFREY BERTOLDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1619 N GREENWOOD ST, SUITE 103, PUEBLO, CO 81003-2644
(719) 542-2167
(719) 542-0320
Mailing address
PO BOX 11512, PUEBLO, CO 81001-0512
(719) 542-2167
(719) 542-0320
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
35094
CO
2085R0202X
Diagnostic Radiology Physician
Primary
35094
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01350941
—
CO
Enumeration date
05/25/2006
Last updated
04/17/2008
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