Individual
JARON LEE PETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1331 STATE ST STE 340, LA PORTE, IN 46350-3112
(219) 379-3166
Mailing address
1331 STATE ST STE 340, LA PORTE, IN 46350-3112
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01094579A
IN
Other
Enumeration date
03/26/2019
Last updated
08/26/2024
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