MEDICARE: JAMES PETTET DPM PC INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	450	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN2228	OTHER	CO	RAILROAD MEDICARE GROUP PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1053409409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES PETTET DPM PC INC

Provider Business Mailing Address
First Line	:	151 W MINERAL AVE STE 110
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-4510
Country	:	US
Telephone Number	:	303-730-2955
Fax Number	:	303-798-7037

Provider Business Practice Location Address
First Line	:	151 W MINERAL AVE STE 110
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-4510
Country	:	US
Telephone Number	:	303-730-2955
Fax Number	:	303-798-7037

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES PETTET
Credential	:	DPM
Telephone Number	:	303-730-2955

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	01/08/2009

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