| Doctor Name: | DR. BRYAN MICHAEL PETTI |
| NPI Number: | 1659635662 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | DOS1554 |
| Business Practice Address: | 11050 Mount Belvedere Blvd Guthrie Army Health Clinic Fort Drum, NY - 136025438 |
| Business Phone Number: | 3157722778 |
| Business Fax Number: | |
| Mailing Address: | 11050 Mount Belvedere Blvd, Guthrie Army Health Clinic FORT DRUM |
| State: | NY |
| Postal Code: | 136025438 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2012 |
| NPI Last Update Date: | 01/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | DOS1554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |