Provider Demographics
NPI:1386042893
Name:CEDAR MALE MEDICAL, PLLC
Entity Type:Organization
Organization Name:CEDAR MALE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-255-5355
Mailing Address - Street 1:1100 LARRABEE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7341
Mailing Address - Country:US
Mailing Address - Phone:360-255-5355
Mailing Address - Fax:360-255-0119
Practice Address - Street 1:1100 LARRABEE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7341
Practice Address - Country:US
Practice Address - Phone:360-255-5355
Practice Address - Fax:360-255-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60320962175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty