Provider Demographics
NPI:1366410763
Name:BITEMAN, JOHN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:BITEMAN
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 1:3770 JANES RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4744
Mailing Address - Country:US
Mailing Address - Phone:707-822-5020
Mailing Address - Fax:707-822-1969
Practice Address - Street 1:3770 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4744
Practice Address - Country:US
Practice Address - Phone:707-822-5020
Practice Address - Fax:707-822-1969
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34068207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056090Medicaid
CAGR0056090Medicaid
CAA35489Medicare UPIN
CADE216ZMedicare PIN