Doctor Name: | MR. STEVEN C PETTICREW |
NPI Number: | 1154499374 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A.-C |
License Number: | 1485 |
Business Practice Address: | 601 East Washington Idabel, OK - 747453319 |
Business Phone Number: | 5802866688 |
Business Fax Number: | 5802666699 |
Mailing Address: | 601 East Washington, IDABEL |
State: | OK |
Postal Code: | 747453319 |
Phone Number: | 5802866688 |
Fax Number: | 5802666699 |
NPI Enumeration Date: | 12/04/2006 |
NPI Last Update Date: | 04/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1485 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |