Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 1747 | NE |
NPI | 1003296153 |
---|---|
Provider Name | Dr. Alan Bartholomew |
First Address | Wright Patterson Afb, OH 45433 |
Second Address | Keesler Afb, MS 39534-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 13/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1747 | (05) | NE |