# CHARLES ROBERT PETTIT MD A MEDICAL CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316268386
- **Authorized official:** DR. CHARLES ROBERT PETTIT M.D. (PRESIDENT)
- **Authorized official phone:** (707) 843-3999

## Contact information

- **Practice address:** 175 CONCOURSE BLVD, SANTA ROSA, CA 95403-8217
- **Practice address phone:** (707) 284-9200
- **Practice address fax:** (707) 284-9204
- **Mailing address:** 3906 HEATHFIELD PL, SANTA ROSA, CA 95404-7627
- **Mailing address phone:** (707) 843-3999
- **Mailing address fax:** (707) 545-3999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/14/2010
- **Last updated:** 08/14/2015