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Individual

DR. ROSS E. PETTIT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1233 34TH ST NW, BEMIDJI, MN 56601-5112
(218) 333-4968
Mailing address
1233 34TH ST NW, BEMIDJI, MN 56601-5112
(218) 333-4968

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
51426
MN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
4231
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1942371752
MN
Enumeration date
11/13/2006
Last updated
11/18/2011
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