MEDICARE: DR. DEAN WAYNE BARTHOLOMEW MD

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
1	207Q00000X	Family Medicine Physician	7067A	WY

General Provider Information

NPI Number	:	1053306662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN WAYNE BARTHOLOMEW MD

Provider Business Mailing Address
First Line	:	1004 GREENFIELD DR
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-2249
Country	:	US
Telephone Number	:	307-710-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 N EVARTS ST
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-2718
Country	:	US
Telephone Number	:	307-764-3721
Fax Number	:	307-764-1865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/21/2022

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