Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO3147 | FL |
N | 222Z00000X | Podiatrist | PO3147 | FL |
Y | 213EP1101X | Primary Podiatric Medicine | PO3147 | FL |
NPI | 1508885872 |
---|---|
Provider Name | Dr. Andrew K. Bartell |
First Address | Jacksonville, FL 32216-1108 |
Second Address | Jacksonville, FL 32216-1108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 22/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340474900 | (05) | FL |
50393 | BLUE CROSS BLUE SHIELD (01) | FL |
99763 | BCBS GROUP (01) | FL |
V01111 | (02) | FL |