Provider Demographics
NPI:1194738260
Name:BARTLETT, RAY (PA)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3009 N BALLAS RD STE 383C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2324
Mailing Address - Country:US
Mailing Address - Phone:314-996-7014
Mailing Address - Fax:
Practice Address - Street 1:723 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2729
Practice Address - Country:US
Practice Address - Phone:636-577-1357
Practice Address - Fax:636-447-1202
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000097226Medicare PIN
MOR22250Medicare UPIN