Provider Demographics
NPI:1760411292
Name:BITTAR, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:BITTAR
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 1:4101 JAMES CASEY ST
Mailing Address - Street 2:STE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1145
Mailing Address - Country:US
Mailing Address - Phone:512-448-4422
Mailing Address - Fax:512-448-4463
Practice Address - Street 1:4101 JAMES CASEY ST
Practice Address - Street 2:STE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1145
Practice Address - Country:US
Practice Address - Phone:512-448-4422
Practice Address - Fax:512-448-4463
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7621207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126278402Medicaid
TX8AJ299OtherBCBS
B21294Medicare UPIN
TX126278402Medicaid