Provider Demographics
NPI:1821083510
Name:PETTIT, WILLIAM ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:PETTIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 334TH ST
Mailing Address - Street 2:WOODWARD RESOURCE CENTER
Mailing Address - City:WOODWARD
Mailing Address - State:IA
Mailing Address - Zip Code:50276-7509
Mailing Address - Country:US
Mailing Address - Phone:515-438-3261
Mailing Address - Fax:515-438-3631
Practice Address - Street 1:1251 334TH ST
Practice Address - Street 2:WOODWARD RESOURCE CENTER
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276-7509
Practice Address - Country:US
Practice Address - Phone:515-438-3261
Practice Address - Fax:515-438-3631
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine