Individual
DR. SHAWN JAMES PETTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9015 ARBOR ST, OMAHA, NE 68124-2056
(402) 384-2600
Mailing address
9911 WESTCHESTER DR, OMAHA, NE 68114-3800
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
19105
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01167
BCBSN
NE
05
—
10024988600
—
NE
05
—
10024988700
—
NE
05
—
10024997200
—
NE
05
—
10024997400
—
NE
05
—
10025039400
—
NE
01
—
2001106
SHARE ADV - CLARKSON W
NE
01
—
2001107
SHARE ADV-BERGAN SURG
NE
01
—
2001164
SHARE ADV - ARBOR ST.
NE
05
—
4909390
—
IA
01
—
6332
MIDLANDS CHOICE
NE
01
—
94522
BCBSIA
IA
Enumeration date
01/11/2007
Last updated
07/09/2007
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