Healthcare Provider Details

I. General information

NPI: 1649289810
Provider Name (Legal Business Name): DAVID BRUCE WITKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 COBURG RD BUILDING 1, SUITE 4
EUGENE OR
97401-4982
US

IV. Provider business mailing address

1755 COBURG RD BUILDING 1, SUITE 4
EUGENE OR
97401-4982
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-2888
  • Fax: 541-683-3289
Mailing address:
  • Phone: 541-683-2888
  • Fax: 541-683-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 13391
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: