Healthcare Provider Details

I. General information

NPI: 1508002726
Provider Name (Legal Business Name): BRYAN LEE WITT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 10/28/2026
Certification Date: 10/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 STATE ROAD 237
TELL CITY IN
47586-8567
US

IV. Provider business mailing address

8885 STATE ROAD 237
TELL CITY IN
47586-8567
US

V. Phone/Fax

Practice location:
  • Phone: 812-547-7011
  • Fax:
Mailing address:
  • Phone: 812-547-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101020200
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberOS12609
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02009142A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number34.010495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: