Individual
MARK D WITTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 S NEW BALLAS RD, DEPT OF NUCLEAR MEDICINE, SAINT LOUIS, MO 63141-8221
(314) 251-6465
(314) 251-4286
Mailing address
11475 OLDE CABIN RD, SUITE 200, SAINT LOUIS, MO 63141-7128
(314) 991-8200
(314) 991-8206
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
R5F02
MO
207U00000X
Nuclear Medicine Physician
036069181
IL
207U00000X
Nuclear Medicine Physician
Primary
R5F02
MO
207UN0902X
Nuclear Imaging & Therapy Physician
R5F02
MO
2085R0202X
Diagnostic Radiology Physician
R5F02
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202885919
—
MO
Enumeration date
02/24/2006
Last updated
02/22/2016
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