Individual
DR. JONATHAN LEWIS WITTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3920 S DUPONT SQ STE C, LOUISVILLE, KY 40207-4615
(812) 282-3899
Mailing address
6034 SW 25TH AVE, PORTLAND, OR 97239
(502) 758-0670
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01082597A
IN
208800000X
Urology Physician
Primary
53076
KY
208800000X
Urology Physician
MD181923
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122620025
IN MEDICARE
IN
05
—
300028277
—
IN
05
—
7100626510
—
KY
Enumeration date
04/16/2010
Last updated
09/26/2019
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