Provider Demographics
NPI:1568448959
Name:BITTER, DOUGLAS A (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:BITTER
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 1:171 NW MEDICAL LOOP
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8822
Mailing Address - Country:US
Mailing Address - Phone:541-673-1016
Mailing Address - Fax:
Practice Address - Street 1:171 MEDICAL LOOP
Practice Address - Street 2:SUITE 160
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8822
Practice Address - Country:US
Practice Address - Phone:541-673-1016
Practice Address - Fax:541-673-0472
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16080208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR095786Medicaid
E79233Medicare UPIN
ORR024WFBPGAMedicare PIN