Provider Demographics
NPI:1073587564
Name:BARTLETT, BRYAN LEONARD (MD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:LEONARD
Last Name:BARTLETT
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:PO BOX 2627
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113
Mailing Address - Country:US
Mailing Address - Phone:817-922-1559
Mailing Address - Fax:817-927-6296
Practice Address - Street 1:1400 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4192
Practice Address - Country:US
Practice Address - Phone:817-922-1599
Practice Address - Fax:817-927-6296
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6422207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21107Medicare UPIN
TX80P551Medicare PIN