Individual
DR. BENJAMIN J PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
500 J. CLYDE MORRIS BLVD, RIVERSIDE REGIONAL MEDICAL CENTER, NEWPORT NEWS, VA 23601-1929
(757) 594-4405
(757) 867-6587
Mailing address
P O BOX 12087, NEWPORT NEWS, VA 23612-2087
(757) 867-6102
(757) 867-6587
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101249325
VA
2085R0202X
Diagnostic Radiology Physician
2010003256
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00980578
RAILROAD MEDICARE
VA
Enumeration date
08/15/2006
Last updated
01/09/2012
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