Provider Demographics
NPI:1912360140
Name:FRANK J WITT DPM
Entity Type:Organization
Organization Name:FRANK J WITT DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-728-4800
Mailing Address - Street 1:407 POTTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3086
Mailing Address - Country:US
Mailing Address - Phone:760-728-4800
Mailing Address - Fax:
Practice Address - Street 1:407 POTTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3086
Practice Address - Country:US
Practice Address - Phone:760-728-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3032261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric