Provider Demographics
NPI:1508874868
Name:FITTERMAN, WILLIAM S (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:FITTERMAN
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 1:313 S 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3611
Mailing Address - Country:US
Mailing Address - Phone:307-399-3119
Mailing Address - Fax:866-827-3930
Practice Address - Street 1:313 S 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3611
Practice Address - Country:US
Practice Address - Phone:307-399-3119
Practice Address - Fax:866-827-3930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7766A207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND82204Medicare ID - Type Unspecified
NDG61602Medicare UPIN