Provider Demographics
NPI:1952406183
Name:BITTL, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BITTL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ROBERT FELDMAN MD PA DEPT 176
Mailing Address - Street 2:PO BOX 850001
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0176
Mailing Address - Country:US
Mailing Address - Phone:352-354-9000
Mailing Address - Fax:352-354-9020
Practice Address - Street 1:125 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0967
Practice Address - Country:US
Practice Address - Phone:352-354-9000
Practice Address - Fax:352-354-9020
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME72895207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251902000Medicaid
FL21063OtherBLUE CROSS BLUE SHIELD
FL251902000Medicaid
FL060040199Medicare PIN
A57182Medicare UPIN