Provider Demographics
NPI:1033138300
Name:DEWITT, PETER EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EUGENE
Last Name:DEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2845
Mailing Address - Country:US
Mailing Address - Phone:620-241-4477
Mailing Address - Fax:620-241-2716
Practice Address - Street 1:1101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2845
Practice Address - Country:US
Practice Address - Phone:620-241-4477
Practice Address - Fax:620-241-2716
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100166460DMedicaid
KS103501Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
KS111000Medicare ID - Type UnspecifiedGROUP NUMBER
KS100166460DMedicaid