Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G54874 | CA |
NPI | 1700962214 |
---|---|
Provider Name | David R. Witt |
First Address | Oakland, CA 94612-3429 |
Second Address | San Jose, CA 95119-1130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G548740 | (05) | CA |
F07967 | (02) |