Provider Demographics
NPI:1851372858
Name:BITNER, ROBERT DALE (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:BITNER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:208 W CASABLANCA AVE
Mailing Address - Street 2:BLDG 1400 CANNON AFB 27 MEDICAL GROUP
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5009
Mailing Address - Country:US
Mailing Address - Phone:505-784-6608
Mailing Address - Fax:505-784-6028
Practice Address - Street 1:208 W CASABLANCA AVE
Practice Address - Street 2:BLDG 1400 CANNON AFB 27 MEDICAL GROUP
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5009
Practice Address - Country:US
Practice Address - Phone:505-784-6608
Practice Address - Fax:505-784-6028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM1041965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN