Provider Demographics
NPI:1881662807
Name:WITTE, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WITTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 NE 1175 PRV
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:64735
Mailing Address - Country:US
Mailing Address - Phone:660-885-8171
Mailing Address - Fax:660-885-5920
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1449
Practice Address - Country:US
Practice Address - Phone:660-647-2182
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG86925Medicare UPIN
7872002Medicare ID - Type Unspecified