Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 926 | TX |
NPI | 1316077761 |
---|---|
Provider Name | Gary Victor Bartholomew |
First Address | Fort Worth, TX 76109-3559 |
Second Address | Fort Worth, TX 76109-3562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 22/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0187254-01 | (05) | TX |
018725402 | (05) | TX |
084933301 | MEDICAID GROUP NUMBER (01) | TX |
T12096 | (02) | TX |