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General NPI Number Information
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NPI Number | 1710983218
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Entity Type | Individual
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Provider Name | WILLIAM SCOTT WITTENBORN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 6811 PORTO FINO CIR
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City | FORT MYERS
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State | FL
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Zip | 33912-4354
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Country | US
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Telephone | 239-561-2313
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Fax | 888-500-2420
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Provider Business Mailing Address
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Address Line | 13300 S CLEVELAND AVE STE 56 BOX 261
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City | FORT MYERS
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State | FL
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Zip | 33907-3871
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Country | US
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Telephone | 239-561-2313
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Fax | 888-500-2420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME87881
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License Number State | FL
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