Provider Demographics
NPI:1104012566
Name:WITTERSHEIM, DANIEL ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALLEN
Last Name:WITTERSHEIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6300 E LAKE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6770
Mailing Address - Country:US
Mailing Address - Phone:228-230-2663
Mailing Address - Fax:228-206-1192
Practice Address - Street 1:6300 E LAKE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-6770
Practice Address - Country:US
Practice Address - Phone:228-230-2663
Practice Address - Fax:228-206-1192
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS22559207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery