Healthcare Provider Details

I. General information

NPI: 1881662807
Provider Name (Legal Business Name): RICHARD A WITTE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N MAIN ST
WINDSOR MO
65360-1449
US

IV. Provider business mailing address

981 NE 1175 PRV
WINDSOR MO
64735
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2182
  • Fax:
Mailing address:
  • Phone: 660-885-8171
  • Fax: 660-885-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8678
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: