Organization
PHOENIX OBSTERICS/GYNECOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERTRAM WALLS MD (PRESIDENT)
(954) 838-2371
Entity
Organization
Contact information
Practice address
500 SE 17TH ST, SUITE 100, FT LAUDERDALE, FL 33316-2547
(919) 425-1565
(919) 425-0478
Mailing address
3114 CROASDAILE DR STE 200, PHOENIX OBSTETRICS/GYNECOLOGY, LLC, DURHAM, NC 27705-2508
(919) 425-1565
(919) 425-0478
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME43546
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269096903
—
FL
Enumeration date
05/06/2006
Last updated
08/10/2019
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