Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 51756 | GA |
NPI | 1770505919 |
---|---|
Provider Name | Dr. Scott Charles Bartley |
First Address | St. Cloud, MN 56303 |
Second Address | Saint Cloud, MN 56303-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H64663 | (02) | GA |