Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0014196 | FL |
NPI | 1013959741 |
---|---|
Provider Name | Bruce Edward Wiita |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Jupiter, FL 33458-7202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 10/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1022104 | CAREPLUS (01) | FL |
1261707 | WELLCARE-MEDICARE (01) | FL |
210784 | AVMED (01) | FL |
2180836 | CIGNA (01) | FL |
D58084 | (02) | FL |
P01649432 | RR MEDICARE (01) | FL |
P971351 | OPTIMUM (01) | FL |
P996325 | FREEDOM (01) | FL |
QMP000004225143 | MOLINA (01) | FL |