Provider Demographics
NPI:1194793505
Name:BARTON, BRUCE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALLEN
Last Name:BARTON
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 1:1725 E 19TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5437
Mailing Address - Country:US
Mailing Address - Phone:918-748-8381
Mailing Address - Fax:918-403-6328
Practice Address - Street 1:1725 E 19TH ST
Practice Address - Street 2:STE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-8381
Practice Address - Fax:918-403-6328
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17758207RS0012X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096930AMedicaid
44174920Z003OtherBLUE CROSS BLUE SHIELD
OKOKAAA1333Medicare PIN
44174920Z003OtherBLUE CROSS BLUE SHIELD