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MR. GLEN ROSS PETTENGER PA-C

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1801910609

Individual Registrant:
MR. GLEN ROSS PETTENGER PA-C
Gender: M
Not Sole Proprietor

Location and contact information for practice:
102 WEST MAIN STREET  CENTERVILLE, TX 75833 US
Tel: 903-536-2313  Fax: 903-536-2207

Contact information for business:
8148 FM 1511  OAKWOOD, TX 75855-4067 US
Tel: 903-536-2810  Fax: --

Registration Information:
NPI: 1801910609
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical
TXPA00952

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS TX - Page 1



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