Provider Demographics
NPI:1316064942
Name:WITT, MARK. W (DO)
Entity type:Individual
Prefix:DR
First Name:MARK.
Middle Name:W
Last Name:WITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2430
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3960 W CRAIG RD
Practice Address - Street 2:SUITE102
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2731
Practice Address - Country:US
Practice Address - Phone:702-473-8380
Practice Address - Fax:702-473-8383
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1316064942Medicaid
NVBR775WMedicare PIN
NVBR775VMedicare PIN