MEDICARE: JAMES M BOTHWELL 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	L4870	TX
2	207X00000X	Orthopaedic Surgery Physician	L4870	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00404028	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1225060155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M BOTHWELL MD

Provider Business Mailing Address
First Line	:	1651 W ROSEDALE ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7437
Country	:	US
Telephone Number	:	817-930-2030
Fax Number	:	817-930-2031

Provider Business Practice Location Address
First Line	:	1651 W ROSEDALE ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7437
Country	:	US
Telephone Number	:	817-930-2030
Fax Number	:	817-930-2031

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/15/2024

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Directions to “ JAMES M BOTHWELL MD” Practice Location

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