Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | S5840 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | S5840 | TX |
NPI | 1225482466 |
---|---|
Provider Name | Matthew Bartow |
First Address | Marble Falls, TX 78654-5708 |
Second Address | Marble Falls, TX 78654-5708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 10/07/2020 |