Individual
JAMES A PETTERCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3015 N. BALLAS, DEPT OF PATHOLOGY, ST. LOUIS, MO 63131
(314) 996-5551
(314) 996-5551
Mailing address
3015 N. BALLAS, DEPT OF PATHOLOGY, ST. LOUIS, MO 63131
(314) 996-5551
(314) 996-5551
Taxonomy
Speciality
Code
Description
License number
State
207ZF0201X
Forensic Pathology Physician
Primary
036-101883
IL
207ZP0101X
Anatomic Pathology Physician
036-101883
IL
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
036-101883
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598832032
—
MO
Enumeration date
11/29/2006
Last updated
10/01/2008
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