Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 41000444A | IN |
NPI | 1073182648 |
---|---|
Provider Name | Chase Nathaniel Witter |
First Address | Evansville, IN 47714-0111 |
Second Address | Evansville, IN 47714-0111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |