Provider Demographics
NPI:1518062215
Name:BARTGIS, BRENT ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:BARTGIS
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 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-326-6501
Mailing Address - Fax:417-328-6338
Practice Address - Street 1:1155 W PARKVIEW
Practice Address - Street 2:SUITE 1F
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-7800
Practice Address - Country:US
Practice Address - Phone:417-326-8700
Practice Address - Fax:417-777-8173
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007668208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00070598OtherPALMETTO GBA RAILROAD
MOH71281Medicare UPIN
002013888Medicare Oscar/Certification