Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 39762 | CO |
NPI | 1013991678 |
---|---|
Provider Name | Samir Ezzeldin Witta |
First Address | Golden, CO 80401-5027 |
Second Address | Golden, CO 80401-5027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 13/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82076529 | (05) | CO |
I13321 | (02) |