Provider Demographics
NPI:1851352165
Name:BARTHOLOMEW, ROYCE BAIRD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:BAIRD
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9914
Mailing Address - Country:US
Mailing Address - Phone:801-372-1888
Mailing Address - Fax:
Practice Address - Street 1:5674 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9914
Practice Address - Country:US
Practice Address - Phone:801-372-1888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215642-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT202438385 00001OtherCIGNA
UT71685OtherPUBLIC EMPLOYEES HEALTH P