Individual
JOHN T WITTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2235 E GALA ST, MERIDIAN, ID 83642-8026
(208) 887-3724
(208) 887-3724
Mailing address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 343-1702
(208) 342-7042
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M-5529
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005904
BLUE SHIELD OF IDAHO
ID
05
—
002733600
—
ID
01
—
100001868
RAILROAD MEDICARE
ID
01
—
55293
BLUE CROSS OF IDAHO
ID
Enumeration date
09/20/2005
Last updated
09/21/2018
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