Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4004 | CA |
Y | 222Z00000X | Podiatrist | E4004 | CA |
NPI | 1063449874 |
---|---|
Provider Name | Dr. David G Bartis |
First Address | Norwalk, CA 90650-2557 |
Second Address | Norwalk, CA 90650-2557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E40040 | BLUE SHIELD (01) | CA |
000E40041 | (05) | CA |
D00127333 | RAIL ROAD MEDICARE (01) | |
U61494 | (02) | CA |