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General NPI Number Information
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NPI Number | 1659421543
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Entity Type | Individual
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Provider Name | SHAWN JAMES PETTIS MD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 9015 ARBOR ST
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City | OMAHA
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State | NE
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Zip | 68124-2056
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Country | US
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Telephone | 402-384-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 9911 WESTCHESTER DR
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City | OMAHA
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State | NE
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Zip | 68114-3800
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Country | US
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Telephone |
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Fax |
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 19105
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License Number State | NE
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