Individual
MR. DAVID WAYNE DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8808 BRONCO LANE, SUITE 1, LAGO VISTA, TX 78645
(512) 267-1877
(512) 267-1726
Mailing address
8008 BRONCO LN STE 1, LAGO VISTA, TX 78645-4151
(512) 267-1877
(512) 267-1726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07432
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
319707YLPS
WELLMED MEDICARE
TX
01
—
3383028-01
WELLMED MEDICAID
TX
Enumeration date
01/03/2007
Last updated
11/29/2022
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