Individual
JODY L PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 SW 13TH AVE, PORTLAND, OR 97205-1902
(503) 221-0161
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205-1902
(503) 221-0161
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD20585
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110153060
RR MEDICARE
OR
Enumeration date
07/11/2006
Last updated
07/21/2022
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