Provider Demographics
NPI:1952363343
Name:WITT, JEFFREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
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 1:131 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2218
Mailing Address - Country:US
Mailing Address - Phone:727-329-1600
Mailing Address - Fax:
Practice Address - Street 1:560 JACKSON ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1405
Practice Address - Country:US
Practice Address - Phone:727-329-1600
Practice Address - Fax:727-329-1694
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38294207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65517100Medicaid
FL65517100Medicaid
D57401Medicare UPIN