Individual
JOHN NICK PETELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5295 PRESERVE PARKWAY, SUITE 100, HOOVER, AL 35244
(205) 987-4444
(205) 987-4451
Mailing address
5295 PRESERVE PARKWAY, SUITE 100, HOOVER, AL 35244
(205) 987-4444
(205) 987-4451
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11468
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000026579
—
AL
05
—
009911025
—
AL
01
—
51026579
BLUE CROSS OF ALABAMA
AL
01
—
51510837
BLUE CROSS OF ALABAMA
AL
Enumeration date
07/19/2006
Last updated
01/04/2016
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