Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | H7120 | TX |
N | 111NI0900X | Internist | H7120 | TX |
N | 207U00000X | Nuclear Medicine Specialist | H7120 | TX |
NPI | 1063544070 |
---|---|
Provider Name | Stephen P Bartold |
First Address | Midland, TX 79705-1743 |
Second Address | Midland, TX 79705-1743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0030MM | BCBS OF TEXAS (01) | TX |
D43539 | (02) | TX |
H7120 | PHYSICIANS PERMIT (01) | TX |