Provider Demographics
NPI:1598366791
Name:WITTMER, ERICH (PA, SA-C)
Entity Type:Individual
Prefix:
First Name:ERICH
Middle Name:
Last Name:WITTMER
Suffix:
Gender:M
Credentials:PA, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LINKS DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-4542
Mailing Address - Country:US
Mailing Address - Phone:956-407-9893
Mailing Address - Fax:
Practice Address - Street 1:316 CONQUEST STE 300
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3012
Practice Address - Country:US
Practice Address - Phone:956-407-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
TX1353363A00000X
PR1353-P.A.363AM0700X
AZ10302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical