Individual
KEITH ALEX PETTIGREW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1204 E CHEVES ST, FLORENCE, SC 29506-2710
(843) 673-0122
Mailing address
1204 E CHEVES ST, FLORENCE, SC 29506-2710
(843) 673-0122
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4093PA
—
SC
Enumeration date
01/13/2020
Last updated
03/24/2020
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