Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 94-09261 | KS |
Y | 208600000X | Surgeon | 94-09261 | KS |
NPI | 1003344060 |
---|---|
Provider Name | Bradon Bitter |
First Address | Wichita, KS 67214-3124 |
Second Address | Wichita, KS 67214-3124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2017 |
Last Update Date | 02/06/2017 |