Individual
MARK D WITTRY
Active
Individual
MARK D WITTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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