Pettit, Robert John
Pettit, Robert John is an individual health care provider with primary practice located at 3430 Washington Pkwy , Idaho Falls ID 83404-7579. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Pettit, Robert John can be contacted via phone (208) 523-3060.Contact Information
Primary practice address
3430 Washington Pkwy
Idaho Falls ID 83404-7579
Phone: (208) 523-3060
Fax: (208) 523-0028
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | M6067 | Idaho |
Profile Details
| NPI number | 1518071174 |
|---|---|
| LBN Legal business name | Pettit, Robert John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 19th, 2006 |
| Last updated | Sep 10th, 2009 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518071174 | NPPES |
| Montana | MEDICAID | 0117419 | |
| Montana | MEDICAID | 114945800 | |
| Montana | Other | 000010005951 | |
| Montana | MEDICAID | 1285786046 | |
| Montana | MEDICAID | 002298200 | |
| Montana | Other | 10678 |
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