Healthcare Provider Details

I. General information

NPI: 1760663595
Provider Name (Legal Business Name): SYLVAN BARTLETT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 N LOVINGTON HWY COMPLEX 5, SUITE 7
HOBBS NM
88240-9131
US

IV. Provider business mailing address

1900 PECAN VALLEY DR
MCKINNEY TX
75070-8313
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-0404
  • Fax: 575-393-0093
Mailing address:
  • Phone: 214-592-0404
  • Fax: 214-592-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberE7810
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number87317
License Number StateNM

VIII. Authorized Official

Name: DR. SYLVAN BARTLETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 575-392-0404