Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | L4870 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | L4870 | TX |
NPI | 1225060155 |
---|---|
Provider Name | James M Bothwell |
First Address | Fort Worth, TX 76132-4265 |
Second Address | Fort Worth, TX 76132-4249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
174234802 | (05) | TX |
P00404028 | RAILROAD MEDICARE (01) |