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Individual

PHILIP GARY PETTETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8540 N ARNOLD PALMER DR, TUCSON, AZ 85742-9595
(816) 206-0397
Mailing address
8540 N ARNOLD PALMER DR, TUCSON, AZ 85742-9595
(816) 206-0397

Taxonomy

Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
04-24446
KS
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
102961
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100147450A
KS
05
203725403
MO
Enumeration date
04/26/2006
Last updated
01/07/2013
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