Healthcare Provider Details

I. General information

NPI: 1841233285
Provider Name (Legal Business Name): PETER D. WITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93638-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93638-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6277
  • Fax: 559-353-5424
Mailing address:
  • Phone: 559-353-6277
  • Fax: 559-353-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA44774
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA44774
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA44774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: