Healthcare Provider Details

I. General information

NPI: 1619973989
Provider Name (Legal Business Name): JAMES E PETRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 46TH AVE
EAST MOLINE IL
61244-4281
US

IV. Provider business mailing address

865 LINCOLN RD STE L10
BETTENDORF IA
52722-4159
US

V. Phone/Fax

Practice location:
  • Phone: 309-796-2329
  • Fax: 309-796-1146
Mailing address:
  • Phone: 563-355-9191
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036091692
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: