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Individual

TRAVIS J. WITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
116 E 11TH ST, SUITE 101, SPENCER, IA 51301-4300
(712) 264-3500
Mailing address
116 E 11TH ST, SUITE 101, SPENCER, IA 51301-4300
(712) 264-3500

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41225
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1124344833
MEDICARE NPI
IA
05
1124344833
IA
01
I54910014
MEDICARE PTAN
IA
Enumeration date
04/20/2010
Last updated
01/14/2014
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