Provider Demographics
NPI:1487630489
Name:WITTMER, JASON B (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:WITTMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1601 NW 114TH ST
Mailing Address - Street 2:SUITE 347
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7007
Mailing Address - Country:US
Mailing Address - Phone:515-224-1777
Mailing Address - Fax:515-222-0226
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:SUITE 347
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-7007
Practice Address - Country:US
Practice Address - Phone:515-224-1777
Practice Address - Fax:515-222-0226
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA36343207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469304Medicaid
IA02019OtherWELLMARK
IA266915OtherCOVENTRY
IAIA0143OtherUHC OF THE RIVER VALLEY
IAIA0143OtherUHC OF THE RIVER VALLEY
IA0469304Medicaid