Individual
DR. BRUCE BEN PETTIGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2448 E 81ST ST STE 3700, TULSA, OK 74137-4257
(918) 492-4122
(918) 492-7451
Mailing address
2448 E 81ST ST STE 3700, TULSA, OK 74137-4257
(918) 492-4122
(918) 492-7451
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
13121
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100089490A
—
OK
05
—
200020920 A
—
OK
Enumeration date
07/04/2006
Last updated
11/07/2024
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