Individual
DR. KENNETH A PETTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4795 LARIMER PARKWAY, JOHNSTOWN, CO 80534
(970) 669-8881
(970) 669-4200
Mailing address
4795 LARIMER PARKWAY, JOHNSTOWN, CO 80534
(970) 669-8881
(970) 669-4200
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
29524
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01295245
—
CO
Enumeration date
11/10/2005
Last updated
03/23/2015
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