Individual
DR. PETER C WITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
630 W MAPLE ST, FARMINGTON, NM 87401-6113
(505) 609-6349
(505) 599-4679
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
036062328
IL
207RG0100X
Gastroenterology Physician
34642
CO
207RG0100X
Gastroenterology Physician
49164
AZ
207RG0100X
Gastroenterology Physician
Primary
MD2015-0843
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01346428
—
CO
05
—
10025926100
—
NE
05
—
1255319877
—
WY
05
—
1J2390
—
NM
01
—
P00944654
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
01/04/2006
Last updated
05/06/2025
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