Provider Demographics
NPI:1073672135
Name:BARTHOLOMEW, JONATHEN (DO)
Entity Type:Individual
Prefix:
First Name:JONATHEN
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N 400 W
Mailing Address - Street 2:C12
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1909
Mailing Address - Country:US
Mailing Address - Phone:801-224-4550
Mailing Address - Fax:801-224-1057
Practice Address - Street 1:171 N 400 W
Practice Address - Street 2:C12
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:801-224-4550
Practice Address - Fax:801-224-1057
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT63837791204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$005Medicaid