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NPI Code Detail

MEDICARE: GARY VICTOR BARTHOLOMEW D.P.M.

MEDICARE: GARY VICTOR BARTHOLOMEW D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery Podiatrist926TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316077761
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY VICTOR BARTHOLOMEW D.P.M.
Provider Business Mailing Address
First Line : 5450 CLEARFORK MAIN ST STE 410
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-3559
Country : US
Telephone Number : 817-505-0233
Fax Number :
Provider Business Practice Location Address
First Line : 5450 CLEARFORK MAIN ST STE 220
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-3562
Country : US
Telephone Number : 817-505-0233
Fax Number : 817-332-3172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 10/22/2019

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