Healthcare Provider Details

I. General information

NPI: 1821381997
Provider Name (Legal Business Name): JUSTIN HULL BARTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 GOLDEN RD
TYLER TX
75701-8336
US

IV. Provider business mailing address

3414 GOLDEN RD
TYLER TX
75701-8336
US

V. Phone/Fax

Practice location:
  • Phone: 903-939-7500
  • Fax: 903-939-7728
Mailing address:
  • Phone: 903-939-7500
  • Fax: 903-939-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberS4442
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberS4442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: