Provider Demographics
NPI:1396795928
Name:BITAR, JAY BRADLEY (MD)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:BRADLEY
Last Name:BITAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:BITAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:122 KINCARDINE DR.
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715
Mailing Address - Country:US
Mailing Address - Phone:407-716-9069
Mailing Address - Fax:407-804-9393
Practice Address - Street 1:ST. JAMES HOSPITAL
Practice Address - Street 2:400 S. CLARK ST
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701
Practice Address - Country:US
Practice Address - Phone:407-804-9199
Practice Address - Fax:407-804-9393
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051776207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257731300Medicaid
FL34924OtherBLUE CROSS
A78586Medicare UPIN
FL257731300Medicaid