Provider Demographics
NPI:1780688713
Name:BITTNER, JEFFREY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLIAM
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 1:1005 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6414
Mailing Address - Country:US
Mailing Address - Phone:641-682-8761
Mailing Address - Fax:641-682-2764
Practice Address - Street 1:1005 PENNSYLVANIA AVE
Practice Address - Street 2:STE 204
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6414
Practice Address - Country:US
Practice Address - Phone:641-682-8761
Practice Address - Fax:641-682-2764
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28585207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0081893Medicaid
IA0081893Medicaid
F35808Medicare UPIN