Healthcare Provider Details

I. General information

NPI: 1023039724
Provider Name (Legal Business Name): DAVID PETTIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT #0861
DENVER CO
80256-0001
US

IV. Provider business mailing address

PO BOX 346
MESA CO
81643-0346
US

V. Phone/Fax

Practice location:
  • Phone: 866-898-7136
  • Fax: 616-975-9824
Mailing address:
  • Phone: 970-268-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number44370
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: