Individual
DR. TRENT LEON PETTIJOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6300 W PARKER RD, MOB II 125, PLANO, TX 75093-8100
(469) 800-4400
(469) 800-4410
Mailing address
6300 W PARKER RD, MOB II 125, PLANO, TX 75093-8100
(469) 800-4400
(469) 800-4410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J4433
TX
207RC0000X
Cardiovascular Disease Physician
J4433
TX
207RI0011X
Interventional Cardiology Physician
Primary
J4433
TX
207U00000X
Nuclear Medicine Physician
J4433
TX
207UN0901X
Nuclear Cardiology Physician
J4433
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036498602
—
TX
05
—
036498603
—
TX
05
—
036498604
—
TX
05
—
036498605
—
TX
01
—
8CX370
BCBSTX
TX
Enumeration date
06/25/2006
Last updated
01/18/2023
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