Pettibon, Michael D.

Pettibon, Michael D. is an individual health care provider with primary practice located at 6606 Lbj Fwy Ste 200, Dallas TX 75240. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Pettibon, Michael D. can be contacted via phone (972) 715-5000.

Contact Information

Primary practice address
6606 Lbj Fwy Ste 200 Dallas TX 75240
Phone: (972) 715-5000
Fax: (972) 715-9976
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X H0722 Texas
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X H0722 Texas
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X H0722 Texas

Profile Details

NPI number 1699752097
LBN Legal business name Pettibon, Michael D.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2005
Last updated Jul 1st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699752097 NPPES
Texas MEDICAID 132632410
Texas Other 8EL144
Texas Other P01446653

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