Provider Demographics
NPI:1518917566
Name:PETTIT, HARLAN ERIC (MD)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:ERIC
Last Name:PETTIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PIRATES CV
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2925
Mailing Address - Country:US
Mailing Address - Phone:305-743-0222
Mailing Address - Fax:305-743-0114
Practice Address - Street 1:3301 OVERSEAS HWY
Practice Address - Street 2:FISHERMEN'S HOSPITAL ANESTHESIA DEPT
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2329
Practice Address - Country:US
Practice Address - Phone:305-289-6407
Practice Address - Fax:305-289-6417
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62372207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050084607OtherRAILROAD MEDICARE
FL370761000Medicaid
FL17803OtherBLUE CROSS BLUE SHIELD FL
FL17803OtherBLUE CROSS BLUE SHIELD FL
F34372Medicare UPIN