Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | F9947 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | F9947 | TX |
NPI | 1265450175 |
---|---|
Provider Name | James C Pettit |
First Address | Waco, TX 76710-7218 |
Second Address | Rockdale, TX 76567-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 10/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140233137 | (05) | TX |
140233138 | (05) | TX |
8U8772 | BCBS (01) | TX |
D97620 | (02) | TX |