Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A44774 | CA |
Y | 208600000X | Surgeon | A44774 | CA |
N | 2082S0105X | Plastic Hand Surgeon | A44774 | CA |
N | 208200000X | Surgeon | A44774 | CA |
N | 208600000X | Surgeon | A44774 | CA |
NPI | 1841233285 |
---|---|
Provider Name | Peter D. Witt |
First Address | Madera, CA 93638-8761 |
Second Address | Madera, CA 93638-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E45315 | (02) | CA |