Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH0002359 | FL |
NPI | 1003863515 |
---|---|
Provider Name | Dr. Stephen B. Bittiker |
First Address | Bayonet Point, FL 34667-6782 |
Second Address | Bayonet Point, FL 34667-6782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T88424 | (02) | FL |