Provider Demographics
NPI:1841482999
Name:WITTER FAMILY MEDICINE, PLC
Entity type:Organization
Organization Name:WITTER FAMILY MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-647-4550
Mailing Address - Street 1:305 W 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4982
Mailing Address - Country:US
Mailing Address - Phone:931-647-4550
Mailing Address - Fax:
Practice Address - Street 1:305 W 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4982
Practice Address - Country:US
Practice Address - Phone:931-647-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty