Active NPI
Bruce R Witten, M.D.
- Otolaryngology Physician
- St Augustine, FL
National Provider Identifier
1962425207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- ME0013869
- Practice address
- 301 Health Park Blvd
Suite 323
St Augustine, FL 32086-5793 - Phone
- (904) 829-6441
- Fax
- (904) 829-2452
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | ME0013869 | FL | Primary |
Addresses
Primary practice location
301 Health Park Blvd
Suite 323
St Augustine, FL 32086-5793
Mailing address
301 Health Park Blvd
Suite 323
St Augustine, FL 32086-5793
Phone (904) 829-6441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0013869 | FL | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1962425207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 HEALTH PARK BLVD",
"address_2": "SUITE 323",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865793",
"telephone_number": "904-829-6441",
"fax_number": "904-829-2452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 HEALTH PARK BLVD",
"address_2": "SUITE 323",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865793",
"telephone_number": "904-829-6441",
"fax_number": "904-829-2452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTEN",
"first_name": "BRUCE",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "FL",
"license": "ME0013869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.