Healthcare Provider Details

I. General information

NPI: 1336123017
Provider Name (Legal Business Name): DAVID CLEMENT RITTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 BONITA BEACH RD SE SUITE 102
BONITA SPRINGS FL
34135-4773
US

IV. Provider business mailing address

PO BOX 20642
TAMPA FL
33622-0642
US

V. Phone/Fax

Practice location:
  • Phone: 239-949-1777
  • Fax: 239-498-3777
Mailing address:
  • Phone: 239-949-1777
  • Fax: 239-498-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME71162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: