Provider Demographics
NPI:1891884433
Name:PETTINGER, THOMAS CHRISTOPHER (DO)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:PETTINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14413 EAST SANDS RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-8876
Mailing Address - Country:US
Mailing Address - Phone:520-661-6089
Mailing Address - Fax:520-561-8493
Practice Address - Street 1:14413 EAST SANDS RANCH ROAD
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-8876
Practice Address - Country:US
Practice Address - Phone:520-661-6089
Practice Address - Fax:520-561-8493
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4257207Q00000X
AZ1515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20709Medicare UPIN