MEDICARE: DR. JUSTIN VICTOR BARTOS III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G3139	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00T83U	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720087349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN VICTOR BARTOS III M.D.

Provider Business Mailing Address
First Line	:	4300 CITY POINT DRIVE
Second Line	:	SUITE 200
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8380
Country	:	US
Telephone Number	:	817-255-1940
Fax Number	:	817-255-1977

Provider Business Practice Location Address
First Line	:	1604 HOSPITAL PKWY STE 402
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6932
Country	:	US
Telephone Number	:	817-848-4110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	09/05/2024

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