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MR. GLEN ROSS PETTENGER PA-C
Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1801910609
Individual Registrant:MR. GLEN ROSS PETTENGER PA-C
Gender: M
Not Sole Proprietor
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
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: --
Tel: 903-536-2810 Fax: --
Registration Information:
NPI: 1801910609
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Medical | TX | PA00952 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
