Provider Demographics
NPI:1568464097
Name:BARTHOLOMEW, BRENT FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:FREDERICK
Last Name:BARTHOLOMEW
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 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:653 N TOWN CENTER DR STE 317
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0504
Practice Address - Country:US
Practice Address - Phone:702-382-2900
Practice Address - Fax:702-382-1980
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019546Medicaid
NV1568464097Medicaid
NV2019546Medicaid
NV1568464097Medicaid