Individual
DR. WILLIAM ALFRED PETTIT III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1404 GEKELER LANE, LA GRANDE, OR 97850
(541) 963-3119
(541) 963-3110
Mailing address
1404 GEKELER LANE, LA GRANDE, OR 97850
(541) 963-3119
(541) 963-3110
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
207W00000X
Ophthalmology Physician
Primary
17635
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044607
—
OR
Enumeration date
09/20/2006
Last updated
03/05/2014
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