Provider Demographics
NPI:1609962380
Name:BARTLETT, RICHARD P (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
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 55
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-0055
Mailing Address - Country:US
Mailing Address - Phone:432-631-2178
Mailing Address - Fax:432-558-7064
Practice Address - Street 1:1330 E 8TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4702
Practice Address - Country:US
Practice Address - Phone:432-631-2178
Practice Address - Fax:432-558-7064
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1865208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137939812Medicaid
TX8A5355Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX137939812Medicaid