MEDICARE: SETH H WITTNER PA C

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	207Q00000X	Family Medicine Physician	PA903	NV

General Provider Information

NPI Number	:	1609812973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH H WITTNER PA C

Provider Business Mailing Address
First Line	:	2600 S RAINBOW BLVD
Second Line	:	SUITE 108
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-4006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S RAINBOW BLVD
Second Line	:	SUITE 108
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-4006
Country	:	US
Telephone Number	:	702-655-1400
Fax Number	:	702-655-1417

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	04/30/2013

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