Individual
DR. PAUL PIERRE PETTAVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 SW 10TH AVE, TOPEKA, KS 66604-1301
(785) 354-6963
(785) 354-5241
Mailing address
PO BOX 30309, CHARLESTON, SC 29417-0309
(843) 554-9300
(843) 566-8780
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0427482
KS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
2010023565
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053427
BCBS
KS
05
—
100317860A
—
KS
Enumeration date
03/24/2006
Last updated
08/06/2010
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