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General NPI Number Information
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NPI Number | 1952652067
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Entity Type | Organization
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Legal Business Name | BRUCE J WITMER, M.D., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 6121 N THESTA ST STE 106
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City | FRESNO
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State | CA
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Zip | 93710-8603
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Country | US
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Telephone | 559-432-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 6121 N THESTA ST STE 106
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City | FRESNO
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State | CA
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Zip | 93710-8603
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Country | US
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Telephone | 559-432-5633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BRUCE J WITMER
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Credential | M.D.
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Telephone | 559-432-5633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G47289
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License Number State | CA
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