Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 5101020200 | MI |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | OS12609 | FL |
NPI | 1508002726 |
---|---|
Provider Name | Dr. Bryan Lee Witt |
First Address | Naples, FL 34109-2002 |
Second Address | Naples, FL 34109-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1503LB | FL BLUE (01) | FL |
OD14869 | (02) | MI |