Provider Demographics
NPI:1386808764
Name:LOREN BARTOLE, DPM, LLC
Entity type:Organization
Organization Name:LOREN BARTOLE, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-835-9911
Mailing Address - Street 1:PO BOX 5772
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-5772
Mailing Address - Country:US
Mailing Address - Phone:501-835-9911
Mailing Address - Fax:501-835-9933
Practice Address - Street 1:7509 WARDEN RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5042
Practice Address - Country:US
Practice Address - Phone:501-835-9911
Practice Address - Fax:501-835-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR151213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty