Provider Demographics
NPI:1861421174
Name:WITTER, JAMES D JR (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:WITTER
Suffix:JR
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 1:358 S 10TH ST
Mailing Address - Street 2:PO BOX 110
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-2145
Mailing Address - Country:US
Mailing Address - Phone:402-367-3322
Mailing Address - Fax:402-367-3311
Practice Address - Street 1:358 S 10TH ST
Practice Address - Street 2:
Practice Address - City:DAVID CITY
Practice Address - State:NE
Practice Address - Zip Code:68632-2145
Practice Address - Country:US
Practice Address - Phone:402-367-3322
Practice Address - Fax:402-367-3311
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant