Provider Demographics
NPI:1689664948
Name:BARTLETT, ROY WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WILLIAM
Last Name:BARTLETT
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 1:14050 JUANITA DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5312
Mailing Address - Country:US
Mailing Address - Phone:425-820-2020
Mailing Address - Fax:425-821-9576
Practice Address - Street 1:14050 JUANITA DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5312
Practice Address - Country:US
Practice Address - Phone:425-820-2020
Practice Address - Fax:425-821-9576
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000732208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0004122615OtherAETNA
WA7550BAOtherREGENCE BLUE SHIELD
WA911087550AAOtherUNIFORM
WA000000074817OtherANTHEM
WA1121102Medicaid
WA911087550 98011 B001OtherTRICARE
WA144150144150OtherPREMERA
WACS2502Medicare ID - Type Unspecified
WAE72727Medicare UPIN