Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 1742 | TN |
Y | 207Q00000X | Family Doctor | DO-556 | AL |
N | 207QA0401X | Family Doctor - Addiction Medicine | DO-556 | AL |
NPI | 1841239654 |
---|---|
Provider Name | Edward G. Witt |
First Address | Huntsville, AL 35803-4415 |
Second Address | Huntsville, AL 35803-4415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 26/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4120997 | BLUE CROSS BLUE SHIELD (01) | TN |
G90750 | (02) |