Healthcare Provider Details

I. General information

NPI: 1295717973
Provider Name (Legal Business Name): BARTLETT J WITHERSPOON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

PO BOX 2046
WEST COLUMBIA SC
29171-2046
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-1000
  • Fax:
Mailing address:
  • Phone: 803-461-3000
  • Fax: 803-461-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number72885
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number7243
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: