MATTHEW PETTIS MD NPI 1952988347

NPI Information

NPI: 1952988347
Provider Name: MATTHEW PETTIS, MD
Classification: Student in an Organized Health Care Education/Training Program - 390200000X
Entity Type: Individual
Address:
1201 S GRAND BLVD
SAINT LOUIS, MO
ZIP 63104
Phone: (314) 257-8000
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Matthew Pettis, MD is a student in an organized health care education training program in Saint Louis, MO. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Matthew Pettis, MD NPI is 1952988347. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1201 S GRAND BLVD
SAINT LOUIS, MO
ZIP 63104-016
Phone: (314) 257-8000

The enumeration date for this NPI number is 3/24/2021 and was last updated on 3/26/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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