NPIMap

Organization Active NPI

Bruce a Petitt M.D. P.C.

  • Pediatrics Physician
  • Tuscaloosa, AL
National Provider Identifier
1013077205
Registry record updated Dec 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BRUCE A PETITT M.D. P.C.
Practice address
1060 Fairfax Park
Suite C
Tuscaloosa, AL 35406-2806
Phone
(205) 752-7337
Fax
(205) 752-8013
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bruce A Petitt, M.D.NPI 1811057003
Title
Physician Owner
Phone
(205) 752-7337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1060 Fairfax Park
Suite C
Tuscaloosa, AL 35406-2806

Mailing address

1060 Fairfax Park
Suite C
Tuscaloosa, AL 35406-2806
Phone (205) 752-7337

Other identifiers 1

IdentifierTypeStateIssuer
104775MedicaidAL

Other names 1

  • West Alabama Pediatrics Doing business as

National Provider Directory

National Provider Directory

Locations

1060 Fairfax Park
Ste C
Tuscaloosa, AL 35406
Phone (205) 752-7337

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1013077205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 FAIRFAX PARK",
            "address_2": "SUITE C",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062806",
            "telephone_number": "205-752-7337",
            "fax_number": "205-752-8013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 FAIRFAX PARK",
            "address_2": "SUITE C",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062806",
            "telephone_number": "205-752-7337",
            "fax_number": "205-752-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE A PETITT M.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2010-12-14",
        "status": "A",
        "authorized_official_last_name": "PETITT",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "205-752-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104775",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Alabama Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.