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NPI Code Detail

MEDICARE: DR. RODERICK W. PETTIS M.D.

MEDICARE: DR. RODERICK W. PETTIS M.D.
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
12084P0800XPsychiatry PhysicianA50972CA

General Provider Information

NPI Number : 1518194745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODERICK W. PETTIS M.D.
Provider Business Mailing Address
First Line : 3569 SACRAMENTO ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-1866
Country : US
Telephone Number : 415-441-5716
Fax Number : 415-441-1327
Provider Business Practice Location Address
First Line : 3569 SACRAMENTO ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-1866
Country : US
Telephone Number : 415-441-5716
Fax Number : 415-441-1327
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2009
Last Update Date : 06/15/2009

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