Provider Demographics
NPI:1306863386
Name:WITT, JENS-PETER (MD)
Entity type:Individual
Prefix:
First Name:JENS-PETER
Middle Name:
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 1:1721 E 19TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1242
Mailing Address - Country:US
Mailing Address - Phone:303-762-3472
Mailing Address - Fax:
Practice Address - Street 1:1721 E 19TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1242
Practice Address - Country:US
Practice Address - Phone:303-762-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38991207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51639718Medicaid
COF72973Medicare PIN