Individual
DR. EDWARD WALTER PETTYJOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9110 N LOOP 1604 W STE 104, SAN ANTONIO, TX 78249-3397
(210) 802-7007
Mailing address
15311 ESCARPMENT OAK, HELOTES, TX 78023-5155
(770) 653-7413
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
S1430
TX
207XS0117X
Orthopaedic Surgery of the Spine Physician
S1430
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400888001
—
TX
Enumeration date
08/03/2013
Last updated
05/05/2025
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