Doctor Name: | DR. BRYAN LEE WITT |
NPI Number: | 1508002726 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 34.010495 |
Business Practice Address: | 13211 Walsingham Rd Largo, FL - 337743518 |
Business Phone Number: | 7275968900 |
Business Fax Number: | 7275959209 |
Mailing Address: | 13211 Walsingham Rd, LARGO |
State: | FL |
Postal Code: | 337743518 |
Phone Number: | 7275968900 |
Fax Number: | 7275959209 |
NPI Enumeration Date: | 12/17/2008 |
NPI Last Update Date: | 07/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 34.010495 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |