Provider Demographics
NPI:1528257755
Name:WITT, CHRIS WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:WILLIAM
Last Name:WITT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6817
Mailing Address - Country:US
Mailing Address - Phone:940-383-1279
Mailing Address - Fax:940-387-0489
Practice Address - Street 1:3319 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6817
Practice Address - Country:US
Practice Address - Phone:940-383-1279
Practice Address - Fax:940-387-0489
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04933363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04933OtherTX LIC #