Provider Demographics
NPI:1063544070
Name:BARTOLD, STEPHEN P (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:BARTOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 POLO PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-1743
Mailing Address - Country:US
Mailing Address - Phone:432-570-1518
Mailing Address - Fax:432-687-6299
Practice Address - Street 1:4907 POLO PKWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-1743
Practice Address - Country:US
Practice Address - Phone:432-570-1518
Practice Address - Fax:432-687-6299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7120207R00000X, 207U00000X, 207UN0901X, 207UN0902X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Not Answered207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030MMOtherBCBS OF TEXAS
TXH7120OtherPHYSICIANS PERMIT
TX0030MMOtherBCBS OF TEXAS
TXD43539Medicare UPIN