MEDICARE: DR. EDWARD FRED BARTSCH 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	208D00000X	General Practice Physician	D0043	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8B5900	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1588714851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD FRED BARTSCH MD

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77492-0146
Country	:	US
Telephone Number	:	281-391-3185
Fax Number	:	281-391-3749

Provider Business Practice Location Address
First Line	:	5207 E 5TH ST
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-2119
Country	:	US
Telephone Number	:	281-391-3185
Fax Number	:	281-391-3749

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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