Basic Information
| Provider Information | |||||||||
| NPI: | 1720087349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTOS | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | VICTOR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 CITY POINT DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551940 | ||||||||
| FaxNumber: | 8172551977 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 CITY POINT DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551940 | ||||||||
| FaxNumber: | 8172551977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G3139 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00T83U | 01 | TX | MEDICARE PTAN | OTHER | 098615005 | 05 | TX | MEDICAID |