Individual
DR. JONATHAN MATTHEW PETTEGREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
609 E ORANGEBURG AVE, SUITE 201, MODESTO, CA 95350-5512
(209) 572-3224
(209) 572-4528
Mailing address
609 E ORANGEBURG AVE, SUITE 201, MODESTO, CA 95350-5512
(209) 572-3224
(209) 572-4528
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
20A13395
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/10/2009
Last updated
06/23/2014
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