Provider Demographics
NPI:1538147046
Name:BARTLETT, DANNY W (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:W
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1119
Mailing Address - Country:US
Mailing Address - Phone:816-630-6699
Mailing Address - Fax:
Practice Address - Street 1:1236 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1119
Practice Address - Country:US
Practice Address - Phone:816-630-6699
Practice Address - Fax:816-637-2028
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003007033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208343103Medicaid
I05851Medicare UPIN
MO208343103Medicaid