Provider Demographics
NPI:1942287206
Name:WITTGROVE, ALAN CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CRAIG
Last Name:WITTGROVE
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 1:12865 POINTE DEL MAR WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3860
Mailing Address - Country:US
Mailing Address - Phone:858-554-1770
Mailing Address - Fax:858-554-1771
Practice Address - Street 1:12865 POINTE DEL MAR WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:858-554-1770
Practice Address - Fax:858-554-1771
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44693208600000X
NV7110208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW2318461OtherDEA
CAA92511Medicare UPIN