Individual
DR. KURT R PETTIPIECE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD.
Contact information
Practice address
777 AVENUE H, POWELL, WY 82435
(307) 754-7257
Mailing address
777 AVENUE H, POWELL, WY 82435
(307) 754-7257
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3709AWY
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116973400
—
WY
01
—
3709AWY
WY MEDICAL LICENSE #
WY
01
—
427KP93
WY CONTROLLED SUBSTANCE #
WY
Enumeration date
02/01/2006
Last updated
03/07/2023
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