Healthcare Provider Details

I. General information

NPI: 1689664948
Provider Name (Legal Business Name): ROY WILLIAM BARTLETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 JUANITA DR NE SUITE A
BOTHELL WA
98011-5312
US

IV. Provider business mailing address

14050 JUANITA DR NE SUITE A
BOTHELL WA
98011-5312
US

V. Phone/Fax

Practice location:
  • Phone: 425-820-2020
  • Fax: 425-821-9576
Mailing address:
  • Phone: 425-820-2020
  • Fax: 425-821-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOP00000732
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0004122615
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerAETNA
# 2
Identifier7550BA
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerREGENCE BLUE SHIELD
# 3
Identifier911087550AA
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerUNIFORM
# 4
Identifier000000074817
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerANTHEM
# 5
Identifier1121102
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 6
Identifier911087550 98011 B001
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerTRICARE
# 7
Identifier144150144150
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerPREMERA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: