Provider Demographics
NPI:1205830023
Name:PITT, JAMES BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRUCE
Last Name:PITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3220 BLUFF CREEK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3525
Mailing Address - Country:US
Mailing Address - Phone:573-443-8773
Mailing Address - Fax:573-443-6843
Practice Address - Street 1:3220 BLUFF CREEK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3525
Practice Address - Country:US
Practice Address - Phone:573-443-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36954208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO28058OtherGHP
MO3481OtherHEALTHCARE USA
MO431428562OtherGREAT WEST
MO21957OtherANTHEM BLUECROSS BLUESHIE
MO246644900Medicaid
MO4343705OtherAETNA
MOE96533OtherMERCY
MO9134339OtherPHCS
MO1284517OtherUNITED HEALTHCARE
MO238659OtherHEALTHLINK, INC
MO431428562OtherGREAT WEST
MOMA3716002Medicare PIN
MO246644900Medicaid