Individual
DR. MICHAEL D. PETTIBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6606 LBJ FWY, STE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
H0722
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
H0722
TX
208VP0014X
Interventional Pain Medicine Physician
H0722
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132632410
—
TX
01
—
8EL144
BCBS
TX
01
—
P01446653
RAILROAD
TX
Enumeration date
12/27/2005
Last updated
07/01/2020
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