Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH2180 | FL |
NPI | 1194920371 |
---|---|
Provider Name | Dr. Carl D Bartholomew |
First Address | Madison, FL 32341-0128 |
Second Address | Madison, FL 32341-0128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 02/06/2008 |