Individual
MR. JEROD PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11403 BLUFFS RDG, SPOTSYLVANIA, VA 22551-8915
(972) 900-9665
Mailing address
11403 BLUFFS RDG, SPOTSYLVANIA, VA 22551-8915
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/31/2021
Last updated
03/31/2021
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