Individual
RYAN PETTIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4424 E FLAMINGO, STE 200, NAMPA, ID 83687
(208) 302-1400
(208) 302-1455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-1400
(208) 302-1455
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2013017878
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
O-1017
ID
Other
Enumeration date
06/13/2013
Last updated
07/21/2022
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