Dr. Theodore G Pettle
Gastroenterologist
1700 Se Hillmoor Dr
Port St Lucie
, Florida 34952-7539
Dr. Theodore G Pettle
Gastroenterologist
1700 Se Hillmoor Dr
Port St Lucie
, Florida 34952-7539
(772) 335-9600
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About
Features
Specialties
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Dr. Theodore G Pettle
- 1700 Se Hillmoor Dr
- Port St Lucie, FL
- Zip : 34952-7539
- Phone : (772) 335-9600
Second Address
- Dr. Theodore G Pettle
- 1700 Se Hillmoor Dr
- Port St Lucie, FL
- Zip : 34952-7539
- Phone : (772) 335-9600
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RG0100X | Gastroenterologist | ME139195 | FL |
| N | 207RG0100X | Gastroenterologist | R6457 | TX |
National Provider Identifier
| NPI | 1003102211 |
|---|---|
| Provider Name | Dr. Theodore G Pettle |
| First Address | Port St Lucie, FL 34952-7539 |
| Second Address | Port St Lucie, FL 34952-7539 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/06/2011 |
| Last Update Date | 14/09/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.