Basic Information
| Provider Information | |||||||||
| NPI: | 1629000484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTOW | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HARDING | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42 | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983830042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604717713 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3417 ENSIGN RD NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934609 | ||||||||
| FaxNumber: | 3604934603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | OP0000896 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | OP0000896 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | OP0000896 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 168006 | 01 | WA | LABOR & INDUSTRIES | OTHER | 300138947 | 01 | RAILROAD MEDICARE | OTHER | 8931358 | 01 | WA | CRIME VICTIMS COMP | OTHER | BB0931902 | 01 | DEA | OTHER | 1037811 | 05 | WA | MEDICAID | 5389BA | 01 | REGENCE BLUESHIELD | OTHER | 4570345 | 01 | AETNA | OTHER |