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General NPI Number Information
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NPI Number | 1053306662
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Entity Type | Individual
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Provider Name | DEAN WAYNE BARTHOLOMEW MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 250 N EVARTS ST
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City | POWELL
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State | WY
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Zip | 82435-2718
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Country | US
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Telephone | 307-764-3721
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Fax | 307-764-1865
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Provider Business Mailing Address
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Address Line | 1004 GREENFIELD DR
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City | POWELL
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State | WY
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Zip | 82435-2249
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Country | US
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Telephone | 307-710-0152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7067A
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License Number State | WY
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