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General NPI Number Information
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NPI Number | 1467444828
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Entity Type | Individual
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Provider Name | TY ROBERT WITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 19610 N 68TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-5515
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Country | US
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Telephone | 623-215-6532
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Fax |
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Provider Business Mailing Address
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Address Line | 19610 N 68TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-5515
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Country | US
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Telephone | 623-215-6532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30147
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD00038457
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License Number State | WA
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