Individual
DR. MARK C. PETITJEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1307 CROWLEY RAYNE HWY, SUITE E, CROWLEY, LA 70526-8210
(337) 788-0975
(337) 788-3744
Mailing address
1307 CROWLEY RAYNE HWY, SUITE E, CROWLEY, LA 70526-8210
(337) 788-0975
(337) 788-3744
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
018518
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1913499
—
LA
Enumeration date
11/15/2005
Last updated
07/09/2007
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