Healthcare Provider Details

I. General information

NPI: 1710983218
Provider Name (Legal Business Name): WILLIAM SCOTT WITTENBORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 PORTO FINO CIR
FORT MYERS FL
33912-4354
US

IV. Provider business mailing address

13300 S CLEVELAND AVE STE 56 BOX 261
FORT MYERS FL
33907-3871
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-2313
  • Fax: 888-500-2420
Mailing address:
  • Phone: 239-561-2313
  • Fax: 888-500-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME87881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: