Provider Demographics
NPI:1982698148
Name:WITWER, BRIAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:WITWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0062
Mailing Address - Country:US
Mailing Address - Phone:970-298-2273
Mailing Address - Fax:970-298-1809
Practice Address - Street 1:750 WELLINGTON AVE STE 3A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6132
Practice Address - Country:US
Practice Address - Phone:970-298-3188
Practice Address - Fax:970-298-3190
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2018-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO41914207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37407074Medicaid
H24674Medicare UPIN
COC806357Medicare PIN