Individual
DR. OPAL E. PETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2301 M ST NW, KAISER PERMANENTE NORTHWEST DC MEDICAL CENTER, WASHINGTON, DC 20037-1427
(202) 419-6200
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
042343
DC
2084P0804X
Child & Adolescent Psychiatry Physician
A48065
CA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD042343
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A480650
—
CA
Enumeration date
10/25/2006
Last updated
02/04/2022
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