Individual
MR. REX L. WITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
215 S PINE ST, SUITE 201, NEWTON, KS 67114-3765
(316) 283-9977
(316) 283-0966
Mailing address
800 MEDICAL CENTER DRIVE, SUITE 240, NEWTON, KS 67114-3765
(316) 283-9977
(316) 283-0966
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-00326
KS
363AS0400X
Surgical Physician Assistant
Primary
15-00326
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042442
TRICARE
KS
05
—
100287500C
—
KS
01
—
111178028
PTAN
KS
01
—
970012263
RR MEDICARE
KS
Enumeration date
04/25/2006
Last updated
01/14/2013
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