Healthcare Provider Details

I. General information

NPI: 1598366791
Provider Name (Legal Business Name): ERICH WITTMER PA, SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S POWER RD STE 106
MESA AZ
85206-5236
US

IV. Provider business mailing address

2301 LINKS DR
EDINBURG TX
78542-4542
US

V. Phone/Fax

Practice location:
  • Phone: 956-407-9893
  • Fax:
Mailing address:
  • Phone: 956-407-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10302
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1353
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1353-P.A.
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17787-I
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: