Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1127 | CA |
Y | 222Z00000X | Podiatrist | E1127 | CA |
NPI | 1043356934 |
---|---|
Provider Name | Joseph Raymond Bartis |
First Address | Moraga, CA 94570-6059 |
Second Address | Walnut Creek, CA 94595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |