Provider Demographics
NPI:1447200282
Name:WITT, BRYAN DAN (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DAN
Last Name:WITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1715
Mailing Address - Country:US
Mailing Address - Phone:620-653-7306
Mailing Address - Fax:620-653-2968
Practice Address - Street 1:353 W 10TH ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1715
Practice Address - Country:US
Practice Address - Phone:620-653-7306
Practice Address - Fax:620-653-2968
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21018208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
EO8799Medicare UPIN
KS009585Medicare ID - Type Unspecified