Provider Demographics
NPI:1295548147
Name:PETTYJOHN, DANIEL M
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:PETTYJOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:BIG HORN
Mailing Address - State:WY
Mailing Address - Zip Code:82833-0492
Mailing Address - Country:US
Mailing Address - Phone:307-217-1283
Mailing Address - Fax:
Practice Address - Street 1:546 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BIG HORN
Practice Address - State:WY
Practice Address - Zip Code:82833
Practice Address - Country:US
Practice Address - Phone:307-217-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist