Provider Demographics
NPI:1528739893
Name:BARTLETT, THOMAS HOLDER
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HOLDER
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:HOLDER
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2460 SE TAMARACK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5453
Mailing Address - Country:US
Mailing Address - Phone:419-509-2057
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program