Individual
JAMES PATRICK PETRUSICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DOCTOR OF AUDIOLOGY
Contact information
Practice address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3385
(541) 298-8676
(541) 298-7746
Mailing address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3385
(541) 298-8676
(541) 298-7746
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23599
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01627946
RR MEDICARE
FL
Enumeration date
04/19/2012
Last updated
05/09/2016
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