Provider Demographics
NPI:1366445876
Name:BARTOLOZZI, JOHN J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BARTOLOZZI
Suffix:JR
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 946
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-0946
Mailing Address - Country:US
Mailing Address - Phone:580-242-5800
Mailing Address - Fax:580-242-5881
Practice Address - Street 1:2411 HERITAGE TRL STE 10
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1652
Practice Address - Country:US
Practice Address - Phone:580-242-5800
Practice Address - Fax:580-242-5881
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21462207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87038Medicare UPIN