Provider Demographics
NPI:1336123017
Name:RITTER, DAVID CLEMENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLEMENT
Last Name:RITTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20642
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0642
Mailing Address - Country:US
Mailing Address - Phone:239-949-1777
Mailing Address - Fax:239-498-3777
Practice Address - Street 1:9776 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4773
Practice Address - Country:US
Practice Address - Phone:239-949-1777
Practice Address - Fax:239-498-3777
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME711622086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32186OtherBCBS
FL250640800Medicaid
FLF85913Medicare UPIN
FL32186OtherBCBS
FL250640800Medicaid