Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN7060 | FL |
NPI | 1053493411 |
---|---|
Provider Name | Dr. Fredric Jay Witkin |
First Address | Miami, FL 33156 |
Second Address | Miami, FL 33156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |