Provider Demographics
NPI:1639150022
Name:WITMER, BRUCE EVAN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:EVAN
Last Name:WITMER
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 1:6255 SHARLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2882
Mailing Address - Country:US
Mailing Address - Phone:775-248-1267
Mailing Address - Fax:775-305-1267
Practice Address - Street 1:6255 SHARLANDS AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2882
Practice Address - Country:US
Practice Address - Phone:775-248-1267
Practice Address - Fax:775-305-1267
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8283208100000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
11191170OtherCAQH
CAXPY194499OtherMEDI-CAL PIN
NV20-16215Medicaid
NV20-16215Medicaid