Provider Demographics
NPI:1134271570
Name:WITTE, MARCIA L (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:WITTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATE ST
Mailing Address - Street 2:MCCALL MEMORIAL HOSPITAL
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-3704
Mailing Address - Country:US
Mailing Address - Phone:208-634-1776
Mailing Address - Fax:208-634-3873
Practice Address - Street 1:209 FOREST ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5256
Practice Address - Country:US
Practice Address - Phone:208-634-1776
Practice Address - Fax:208-634-3873
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010147960OtherBLUE CROSS OF IDAHO
ID806952300Medicaid
I17206Medicare UPIN
1127437Medicare ID - Type Unspecified