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General NPI Number Information
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NPI Number | 1851617732
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Entity Type | Individual
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Provider Name | JONATHAN LEWIS WITTEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 3920 S DUPONT SQ STE C
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City | LOUISVILLE
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State | KY
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Zip | 40207-4615
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Country | US
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Telephone | 812-282-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 6034 SW 25TH AVE
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 502-758-0670
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 01082597A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD181923
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 53076
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License Number State | KY
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