Provider Demographics
NPI:1639238181
Name:BARTOLE, LOREN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:
Last Name:BARTOLE
Suffix:
Gender:F
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR151213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5909190001Medicare NSC
U62923Medicare UPIN
AR5T297Medicare ID - Type Unspecified