Provider Demographics
NPI:1952628646
Name:WITT, BRIAN DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:WITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E 54TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-7214
Mailing Address - Country:US
Mailing Address - Phone:563-421-0555
Mailing Address - Fax:563-421-0559
Practice Address - Street 1:1801 E. 54TH STREET
Practice Address - Street 2:STE 100
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-421-0555
Practice Address - Fax:563-421-0559
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD44909207RP1001X
CAA141309207RP1001X
IAMD-44909207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease