Provider Demographics
NPI:1316077761
Name:BARTHOLOMEW, GARY VICTOR (DPM)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:VICTOR
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 410
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3559
Mailing Address - Country:US
Mailing Address - Phone:817-505-0233
Mailing Address - Fax:
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3562
Practice Address - Country:US
Practice Address - Phone:817-505-0233
Practice Address - Fax:817-332-3172
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX926213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084933301OtherMEDICAID GROUP NUMBER
TX0187254-01Medicaid
TX018725402Medicaid
TX084933301OtherMEDICAID GROUP NUMBER
TXP00613864OtherRAILROAD MEDICARE PIMN
TXCC7989OtherRAILROAD MEDICARE GROUP NUMBER
TX0187254-01Medicaid
TX084933301OtherMEDICAID GROUP NUMBER
TX00GK57Medicare ID - Type Unspecified
TXP00613864OtherRAILROAD MEDICARE PIMN