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Individual

BRYON J WITZEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
621 S NEW BALLAS RD, SUITE 3005B, SAINT LOUIS, MO 63141-8232
(314) 251-7070
(314) 251-7071
Mailing address
621 S NEW BALLAS RD, SUITE 3005B, SAINT LOUIS, MO 63141-8232
(314) 251-7070
(314) 251-7071

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
085-002185
IL
363A00000X
Physician Assistant
Primary
2006034878
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00174465
MEDICARE RAILROAD
IL
01
P00651238
RAILROAD MEDICARE
MO
Enumeration date
07/01/2005
Last updated
03/03/2015
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