Provider Demographics
NPI:1063741924
Name:LON G. BITZER, M.D., P.A.
Entity type:Organization
Organization Name:LON G. BITZER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:G
Authorized Official - Last Name:BITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-534-3923
Mailing Address - Street 1:1801 W 40TH AVE STE 4C
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6961
Mailing Address - Country:US
Mailing Address - Phone:870-534-6400
Mailing Address - Fax:870-534-3441
Practice Address - Street 1:1801 W 40TH AVE STE 4C
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6961
Practice Address - Country:US
Practice Address - Phone:870-534-6400
Practice Address - Fax:870-534-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR42942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119261001Medicaid