Provider Demographics
NPI:1063450237
Name:BARTZ, WILLIAM RYAN (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RYAN
Last Name:BARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W COURT AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2102
Mailing Address - Country:US
Mailing Address - Phone:731-437-2720
Mailing Address - Fax:731-645-5195
Practice Address - Street 1:104 W COURT AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2102
Practice Address - Country:US
Practice Address - Phone:731-437-2720
Practice Address - Fax:731-434-0388
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1733207P00000X
TN1733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4162040OtherBCBS TN
TN3319561Medicaid
TN4162040OtherBCBS TN
TNI43952Medicare UPIN
TN3319561Medicaid
TN33195612Medicare PIN
TN33195613Medicare PIN