MEDICARE: DR. JESSIE MARIE PETTIT MD

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	207Q00000X	Family Medicine Physician	41805	AZ

General Provider Information

NPI Number	:	1821232216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIE MARIE PETTIT MD

Provider Business Mailing Address
First Line	:	2980 N SWAN RD STE 225
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-6024
Country	:	US
Telephone Number	:	520-276-6255
Fax Number	:	520-525-0005

Provider Business Practice Location Address
First Line	:	4008 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3317
Country	:	US
Telephone Number	:	520-326-0850
Fax Number	:	520-326-0849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/12/2026

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