Provider Demographics
NPI:1063411189
Name:WITT, ROBERT A (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:WITT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-2200
Mailing Address - Country:US
Mailing Address - Phone:319-444-3210
Mailing Address - Fax:319-444-4099
Practice Address - Street 1:105 9TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-2200
Practice Address - Country:US
Practice Address - Phone:319-444-3210
Practice Address - Fax:319-444-4099
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant