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NPI Code Detail

MEDICARE: CAROLYN K PETTIT MD

MEDICARE:   CAROLYN K PETTIT  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician20042AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063489474
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN K PETTIT MD
Provider Business Mailing Address
First Line : PO BOX 740968
Second Line :
City : DALLAS
State : TX
Zip : 75374-0968
Country : US
Telephone Number : 480-323-3383
Fax Number : 480-323-3358
Provider Business Practice Location Address
First Line : 9003 E SHEA BLVD
Second Line : DEPARTMENT OF PATHOLOGY
City : SCOTTSDALE
State : AZ
Zip : 85260-6709
Country : US
Telephone Number : 480-323-3383
Fax Number : 480-323-3358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2006
Last Update Date : 10/30/2008

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Directions to “ CAROLYN K PETTIT MD” Practice Location

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