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General NPI Number Information
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NPI Number | 1518917566
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Entity Type | Individual
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Provider Name | HARLAN ERIC PETTIT M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 3301 OVERSEAS HWY FISHERMEN'S HOSPITAL ANESTHESIA DEPT
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City | MARATHON
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State | FL
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Zip | 33050-2329
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Country | US
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Telephone | 305-289-6407
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Fax | 305-289-6417
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Provider Business Mailing Address
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Address Line | 103 PIRATES CV
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City | MARATHON
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State | FL
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Zip | 33050-2925
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Country | US
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Telephone | 305-743-0222
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Fax | 305-743-0114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME62372
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME62372
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License Number State | FL
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