Individual
MATTHEW PETTENGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1200
(602) 200-5383
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
POD1049
ME
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC004785L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046148
—
AZ
01
—
AZ0307600
BCBS
AZ
Enumeration date
08/29/2006
Last updated
07/29/2011
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