Provider Demographics
NPI:1295845311
Name:SITZMAN, BRETLEY TODD (MD)
Entity type:Individual
Prefix:DR
First Name:BRETLEY
Middle Name:TODD
Last Name:SITZMAN
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:PO BOX 18260
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8260
Mailing Address - Country:US
Mailing Address - Phone:601-466-0474
Mailing Address - Fax:601-450-7250
Practice Address - Street 1:7125 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-450-7246
Practice Address - Fax:601-450-7250
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17817207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0050000815Medicare ID - Type Unspecified
MSF37057Medicare UPIN