MEDICARE: JAMES D WITTER JR. PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	810	NE

General Provider Information

NPI Number	:	1861421174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D WITTER JR. PA-C

Provider Business Mailing Address
First Line	:	358 S 10TH ST
Second Line	:	PO BOX 110
City	:	DAVID CITY
State	:	NE
Zip	:	68632-2145
Country	:	US
Telephone Number	:	402-367-3322
Fax Number	:	402-367-3311

Provider Business Practice Location Address
First Line	:	358 S 10TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-2145
Country	:	US
Telephone Number	:	402-367-3322
Fax Number	:	402-367-3311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	06/19/2008

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