Provider Demographics
NPI:1275569865
Name:WITTSTRUCK, SARAH C (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:C
Last Name:WITTSTRUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CLAYTON
Other - Last Name:WITTSTRUCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23343 NW COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:386-454-0690
Practice Address - Street 1:1014 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4486
Practice Address - Country:US
Practice Address - Phone:352-376-8211
Practice Address - Fax:352-463-2726
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81697208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262493100Medicaid
H49518Medicare UPIN
FL262493100Medicaid
FL03111YMedicare PIN