Individual
CODY WALLACE DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
201 14TH ST SW, LARGO, FL 33770-3133
(727) 588-5200
Mailing address
9505 49TH ST N APT 1-306, PINELLAS PARK, FL 33782-5275
(701) 425-1036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PAC1142
ND
363AM0700X
Medical Physician Assistant
Primary
9117778
FL
Other
Enumeration date
08/22/2023
Last updated
03/05/2025
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