Individual
BRIAN L PETTIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-3966
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD417309
PA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD206806
LA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
MD417309
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01034231
—
MS
05
—
037212900
—
MD
05
—
101094283
—
PA
01
—
1541821
GATEWAY-WMG
PA
01
—
1628981
HIGHMARK BLUE SHIELD
PA
01
—
20091811
AMERIHEALTH MERCY-WMG
PA
05
—
2371461
—
LA
01
—
280433
UNISON-WMG
PA
01
—
953505
CAREFIRST MD BCBS
MD
Enumeration date
02/20/2006
Last updated
03/02/2015
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