Provider Demographics
NPI:1710983218
Name:WITTENBORN, WILLIAM SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:WITTENBORN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13300 S CLEVELAND AVE STE 56
Mailing Address - Street 2:BOX 261
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3871
Mailing Address - Country:US
Mailing Address - Phone:239-561-2313
Mailing Address - Fax:888-500-2420
Practice Address - Street 1:6811 PORTO FINO CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4354
Practice Address - Country:US
Practice Address - Phone:239-561-2313
Practice Address - Fax:888-500-2420
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2018-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87881208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH91878Medicare UPIN