Individual
MR. DUSTIN BARTLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3800 S NATIONAL AVE, SPRINGFIELD, MO 65807-5209
(417) 875-3800
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2005003803
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005003803
STATE LICENSE
MO
05
—
220024622
—
MO
Enumeration date
09/22/2006
Last updated
12/27/2018
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