Provider Demographics
NPI:1629173398
Name:PITTENGER, DAVID LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:PITTENGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:97 HILL TOP VILLAGE CENTER
Mailing Address - Street 2:SUITE E & F
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1184
Mailing Address - Country:US
Mailing Address - Phone:636-938-6060
Mailing Address - Fax:636-587-9712
Practice Address - Street 1:97 HILL TOP VILLAGE CENTER
Practice Address - Street 2:SUITE E & F
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1184
Practice Address - Country:US
Practice Address - Phone:636-938-6060
Practice Address - Fax:636-587-9712
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOD030648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD41714Medicare UPIN