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1467419317

NPI Code Detail

MEDICARE: PHILIP GARY PETTETT MD

MEDICARE: PHILIP GARY PETTETT 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
1	2080N0001X	Neonatal-Perinatal Medicine Physician	102961	MO
2	2080N0001X	Neonatal-Perinatal Medicine Physician	04-24446	KS

Other Identifiers

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

General Provider Information

NPI Number	:	1467419317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP GARY PETTETT MD

Provider Business Mailing Address
First Line	:	8540 N ARNOLD PALMER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9595
Country	:	US
Telephone Number	:	816-206-0397
Fax Number	:

Provider Business Practice Location Address
First Line	:	8540 N ARNOLD PALMER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9595
Country	:	US
Telephone Number	:	816-206-0397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/07/2013

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Directions to “ PHILIP GARY PETTETT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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