Individual provider · Type 1 NPI
Glen Ross Pettenger, PA-C
Medical Physician Assistant · Centerville, TX
NPI number
1801910609
Active
Practice location
102 West Main Street
Centerville, TX 75833
Fax (903) 536-2207
Mailing address
8148 FM 1511
Oakwood, TX 75855-4067
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA00952 (TX) |
Medical Physician Assistant: Definition to come...
About NPI 1801910609
Glen Ross Pettenger, PA-C's National Provider Identifier is 1801910609, issued on Mar 19, 2007. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Centerville, TX. The record was last updated on Jul 8, 2007.