Individual
MR. REX L. WITTMAN
Active
Individual
MR. REX L. WITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
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
Update your record
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