Healthcare Provider Details

I. General information

NPI: 1609989714
Provider Name (Legal Business Name): NATHAN BITTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 15TH AVE SE STE A
PUYALLUP WA
98372-3750
US

IV. Provider business mailing address

4230 BRIDGEPORT WAY W STE B
UNIVERSITY PLACE WA
98466-4335
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-4311
  • Fax: 253-627-8792
Mailing address:
  • Phone: 253-779-6325
  • Fax: 253-627-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberML20007539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: