Provider Demographics
NPI:1710095211
Name:DEWITT, WARD S (MD)
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:S
Last Name:DEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2825 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 317C
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7420
Mailing Address - Country:US
Mailing Address - Phone:406-728-5428
Mailing Address - Fax:406-728-5458
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:SUITE 317C
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-728-5428
Practice Address - Fax:406-728-5458
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT7276207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0042296Medicaid
MT0042296Medicaid