Provider Demographics
NPI:1609989714
Name:BITTNER, NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BITTNER
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 1:4230 BRIDGEPORT WAY W STE B
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4335
Mailing Address - Country:US
Mailing Address - Phone:253-779-6325
Mailing Address - Fax:253-627-8792
Practice Address - Street 1:400 15TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3750
Practice Address - Country:US
Practice Address - Phone:253-841-4311
Practice Address - Fax:253-627-8792
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML200075392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60006974OtherMD LICENSE
11839467OtherCAQH
WA7058480Medicaid