Provider Demographics
NPI:1861559486
Name:BERTROCHE, J PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:J PATRICK
Middle Name:
Last Name:BERTROCHE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5525 MEREDITH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2334
Mailing Address - Country:US
Mailing Address - Phone:515-334-9484
Mailing Address - Fax:515-334-9498
Practice Address - Street 1:5525 MEREDITH DR
Practice Address - Street 2:SUITE B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2334
Practice Address - Country:US
Practice Address - Phone:515-334-9484
Practice Address - Fax:515-334-9498
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA032202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1861559486Medicaid