Provider Demographics
NPI:1922688811
Name:DE WITTE, ANTON JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:JORDAN
Last Name:DE WITTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ACKLEN PARK DR APT 446
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN
Practice Address - Street 2:POD A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204
Practice Address - Country:US
Practice Address - Phone:615-936-2187
Practice Address - Fax:615-936-3218
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program