Healthcare Provider Details

I. General information

NPI: 1174699235
Provider Name (Legal Business Name): E JAMES WITMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 S ARCH AVE
ALLIANCE OH
44601-4332
US

IV. Provider business mailing address

3825 LINCOLN WAY E
MASSILLON OH
44646-3722
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-7311
  • Fax: 330-823-6344
Mailing address:
  • Phone: 330-478-0038
  • Fax: 330-477-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-03-4033
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: