Healthcare Provider Details

I. General information

NPI: 1225482466
Provider Name (Legal Business Name): MATTHEW BARTOW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S CAPITAL OF TEXAS HWY STE Q900
WEST LAKE HILLS TX
78746-5263
US

IV. Provider business mailing address

701 S CAPITAL OF TEXAS HWY STE Q900
WEST LAKE HILLS TX
78746-5263
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-6970
  • Fax: 512-324-6971
Mailing address:
  • Phone: 512-324-6970
  • Fax: 512-324-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS5840
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberS5840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: