Provider Demographics
NPI:1508002726
Name:WITT, BRYAN LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEE
Last Name:WITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 PINE RIDGE RD STE F
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2002
Mailing Address - Country:US
Mailing Address - Phone:239-325-4090
Mailing Address - Fax:239-325-4091
Practice Address - Street 1:2171 PINE RIDGE RD STE F
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2002
Practice Address - Country:US
Practice Address - Phone:239-325-4090
Practice Address - Fax:239-325-4091
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020200207X00000X
OH34.010495390200000X
FLOS12609207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1503LBOtherFL BLUE
MIPO1223795OtherMEDICARE RAILROAD
MIOD14869Medicare UPIN