Pettyjohn, Edward Walter

Pettyjohn, Edward Walter is an sole proprietor health care provider with primary practice located at 9110 N Loop 1604 W Ste 104 , San Antonio TX 78249-3397. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Pettyjohn, Edward Walter can be contacted via phone (210) 802-7007.

Contact Information

Primary practice address
9110 N Loop 1604 W Ste 104 San Antonio TX 78249-3397
Phone: (210) 802-7007
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine 207XS0117X S1430 Texas
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X S1430 Texas

Profile Details

NPI number 1801228630
LBN Legal business name Pettyjohn, Edward Walter
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 3rd, 2013
Last updated May 5th, 2025 - about last year

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 1801228630 NPPES
Texas MEDICAID 400888001

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