Individual
DR. GRETCHEN G PETTERWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9220 ELLERBE RD, SUITE 700, SHREVEPORT, LA 71106-6739
(318) 681-5282
(318) 681-5284
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-0996
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD.202577
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1079219
—
LA
Enumeration date
05/24/2007
Last updated
01/02/2017
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