Organization
PHOENIX OBSTETRICS AND GYNECOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERTRUM WALLS M.D. (PRESIDENT)
(954) 355-5017
Entity
Organization
Contact information
Practice address
1600 S ANDREWS AVE, FT LAUDERDALE, FL 33316-2510
(954) 355-5017
(954) 714-6335
Mailing address
1600 S ANDREWS AVE, RPICC SERVICES, FT LAUDERDALE, FL 33316-2510
(954) 355-5017
(919) 425-0478
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME43546
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269096902
—
FL
Enumeration date
02/01/2007
Last updated
05/22/2009
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