Provider Demographics
NPI:1780981613
Name:SAMUEL A PETTINA D.O.
Entity type:Organization
Organization Name:SAMUEL A PETTINA D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETTINA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-536-5575
Mailing Address - Street 1:13425 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4009
Mailing Address - Country:US
Mailing Address - Phone:727-536-5575
Mailing Address - Fax:
Practice Address - Street 1:13425 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4009
Practice Address - Country:US
Practice Address - Phone:727-536-5575
Practice Address - Fax:727-536-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty