Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 43873-20 | WI |
Y | 208200000X | Surgeon | 43873-20 | WI |
Y | 208600000X | Surgeon | 43873-20 | WI |
NPI | 1265424485 |
---|---|
Provider Name | David Charles Dewitt |
First Address | Appleton, WI 54913 |
Second Address | Appleton, WI 54913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 23/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34616400 | (05) | WI |
I25593 | (02) |