Provider Demographics
NPI:1831144674
Name:VITT, PAUL C (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:VITT
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:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-0765
Mailing Address - Country:US
Mailing Address - Phone:541-921-3584
Mailing Address - Fax:541-614-1291
Practice Address - Street 1:116 N HIGHWAY 101 UNIT B
Practice Address - Street 2:
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341-1947
Practice Address - Country:US
Practice Address - Phone:541-921-3584
Practice Address - Fax:541-614-1291
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672642Medicaid
MO208732701Medicaid
MO268606Medicare PIN
B33963Medicare UPIN
MO6030000Medicare ID - Type Unspecified
268606Medicare Oscar/Certification
MO208732701Medicaid
MO34556013Medicaid
MO268606Medicare Oscar/Certification