Healthcare Provider Details

I. General information

NPI: 1366445876
Provider Name (Legal Business Name): JOHN J BARTOLOZZI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 HERITAGE TRL STE 10
ENID OK
73703-1652
US

IV. Provider business mailing address

PO BOX 946
ENID OK
73702-0946
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-5800
  • Fax: 580-242-5881
Mailing address:
  • Phone: 580-242-5800
  • Fax: 580-242-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21462
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: