Individual
KELLY R PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1253 NW CANAL BLVD, REDMOND, OR 97756-1334
(541) 548-8131
(541) 526-6608
Mailing address
275 E 200 S, SALT LAKE CITY, UT 84111-2002
(800) 366-1884
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2006-0194
NM
Other
Enumeration date
10/23/2006
Last updated
07/01/2022
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