MEDICARE: DR. JASON B WITTMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	36343	IA
2	207RP1001X	Pulmonary Disease Physician	36343	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	02019	OTHER	IA	WELLMARK
3	266915	OTHER	IA	COVENTRY
4	IA0143	OTHER	IA	UHC OF THE RIVER VALLEY

General Provider Information

NPI Number	:	1487630489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON B WITTMER MD

Provider Business Mailing Address
First Line	:	1601 NW 114TH ST
Second Line	:	SUITE 347
City	:	DES MOINES
State	:	IA
Zip	:	50325-7007
Country	:	US
Telephone Number	:	515-224-1777
Fax Number	:	515-222-0226

Provider Business Practice Location Address
First Line	:	1601 NW 114TH ST
Second Line	:	SUITE 347
City	:	DES MOINES
State	:	IA
Zip	:	50325-7007
Country	:	US
Telephone Number	:	515-224-1777
Fax Number	:	515-222-0226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/15/2014

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Directions to “ DR. JASON B WITTMER MD” Practice Location

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