Individual
DR. THERON M PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 NE 87TH AVE, VANCOUVER, WA 98664-4896
(407) 864-3051
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-4896
(407) 864-3051
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C175441
CA
207R00000X
Internal Medicine Physician
Primary
MD61603161
WA
207R00000X
Internal Medicine Physician
ME91576
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272039600
—
FL
01
—
64060
BCBSFL
—
Enumeration date
12/02/2005
Last updated
04/01/2025
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