Provider Demographics
NPI:1699178715
Name:ALAN, BARTIMAEUS (LMT, ACMT)
Entity type:Individual
Prefix:MR
First Name:BARTIMAEUS
Middle Name:
Last Name:ALAN
Suffix:
Gender:M
Credentials:LMT, ACMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 E HORSEHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4658
Mailing Address - Country:US
Mailing Address - Phone:208-704-0468
Mailing Address - Fax:
Practice Address - Street 1:4718 E HORSEHAVEN AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4658
Practice Address - Country:US
Practice Address - Phone:208-704-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty