Provider Demographics
NPI:1013178284
Name:WITTY, JEFFREY BINGHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BINGHAM
Last Name:WITTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 100
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-2663
Practice Address - Fax:985-230-2665
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204614207X00000X, 207XX0005X
LAPGY-1 INTERN PERMIT207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery