Provider Demographics
NPI:1912993445
Name:PETTIT, ADRIENNE B (DO)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:B
Last Name:PETTIT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 N. SCOTTSDALE RD.
Mailing Address - Street 2:SUITE 603
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5216
Mailing Address - Country:US
Mailing Address - Phone:480-607-3800
Mailing Address - Fax:480-607-3808
Practice Address - Street 1:10900 N. SCOTTSDALE RD.
Practice Address - Street 2:SUITE 603
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5216
Practice Address - Country:US
Practice Address - Phone:480-607-3800
Practice Address - Fax:480-607-3808
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ793069-02Medicaid
AZ793069-02Medicaid
AZZ77543Medicare PIN
AZP00084927Medicare PIN