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NPI Code Detail

MEDICARE: BRUCE EVAN WITMER M.D.

MEDICARE: BRUCE EVAN WITMER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician8283NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111191170OTHERCAQH
2XPY194499OTHERCAMEDI-CAL PIN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639150022
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE EVAN WITMER M.D.
Provider Business Mailing Address
First Line : 6255 SHARLANDS AVE
Second Line :
City : RENO
State : NV
Zip : 89523-2882
Country : US
Telephone Number : 775-248-1267
Fax Number : 775-305-1267
Provider Business Practice Location Address
First Line : 6255 SHARLANDS AVE
Second Line :
City : RENO
State : NV
Zip : 89523-2882
Country : US
Telephone Number : 775-248-1267
Fax Number : 775-305-1267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2005
Last Update Date : 07/16/2021

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