1063544070 NPI number — STEPHEN P BARTOLD MD

Table of content: STEPHEN P BARTOLD MD (NPI 1063544070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063544070 NPI number — STEPHEN P BARTOLD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTOLD
Provider First Name:
STEPHEN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063544070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4907 POLO PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79705-1743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-570-1518
Provider Business Mailing Address Fax Number:
432-687-6299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4907 POLO PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79705-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-570-1518
Provider Business Practice Location Address Fax Number:
432-687-6299
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  H7120 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207U00000X , with the licence number: H7120 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207UN0901X , with the licence number: H7120 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207UN0902X , with the licence number: H7120 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207ZP0102X , with the licence number: H7120 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0030MM . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H7120 . This is a "PHYSICIANS PERMIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".