Provider Demographics
NPI:1538241294
Name:WITTE, EDWIN W (PA)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:W
Last Name:WITTE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:9073 DOERCREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2421
Mailing Address - Country:US
Mailing Address - Phone:314-843-3443
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant