Organization
EMERGENCY MEDICINE DOCTOR OF WACO, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES PETTIT DO (OWNER-PRESIDENT)
(254) 752-9821
Entity
Organization
Contact information
Practice address
3721 HERWOL AVE, WACO, TX 76710-7218
(254) 493-8337
Mailing address
3721 HERWOL AVE, WACO, TX 76710-7218
(254) 493-8337
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
F9947
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167263601
—
TX
Enumeration date
06/25/2007
Last updated
07/29/2014
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