Provider Demographics
NPI:1255437679
Name:BITZER, LON G (MD)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:G
Last Name:BITZER
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:ASHLEY SPECIALTY GENERAL SURGERY
Mailing Address - Street 2:1015 UNITY ROAD
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9443
Mailing Address - Country:US
Mailing Address - Phone:870-364-0567
Mailing Address - Fax:
Practice Address - Street 1:CROSSETT HEALTH FOUNDATION DBA ASHLEY SPEC GEN SURGERY
Practice Address - Street 2:1015 UNITY ROAD
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR020053063OtherPALMETTO GBA
ARB002OtherTRICARE
AR119261001Medicaid
ARE49282Medicare UPIN
ARB002OtherTRICARE