Provider Demographics
NPI:1790708691
Name:BARTHOLD, DAVID ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROY
Last Name:BARTHOLD
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 1:2257 TAYLOR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7790
Mailing Address - Country:US
Mailing Address - Phone:334-270-9914
Mailing Address - Fax:
Practice Address - Street 1:US HWY 11 SOUTH
Practice Address - Street 2:UAB MEDICAL WEST
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022
Practice Address - Country:US
Practice Address - Phone:205-706-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503755OtherBLUE CROSS / BLUE SHIELD
ALC1974Medicare UPIN