NPIMap

Organization Active NPI

William H Pettibon PHD

  • Specialist
  • Sarasota, FL
National Provider Identifier
1104839042
Registry record updated Oct 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PY6096 Issued in FL
Legal business name
WILLIAM H PETTIBON PHD
Practice address
3800 S Tamiami TR
Suite 210
Sarasota, FL 34239-6909
Phone
(941) 366-1693
Fax
(941) 922-7574
NPI assigned
Aug 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2007

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

Authorized official

Name
William Harry Pettibon, PHDNPI 1629267877
Title
Psychologist
Phone
(941) 922-7574

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X PY6096 FL Primary

Addresses

Primary practice location

3800 S Tamiami TR
Suite 210
Sarasota, FL 34239-6909

Mailing address

6521 Keystone Dr
Sarasota, FL 34231-7133
Phone (941) 922-7574

National Provider Directory

National Provider Directory
Tax ID family
William H Pettibon PHD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1104839042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6521 KEYSTONE DR",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342317133",
            "telephone_number": "941-922-7574",
            "fax_number": "941-922-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 S TAMIAMI TR",
            "address_2": "SUITE 210",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342396909",
            "telephone_number": "941-366-1693",
            "fax_number": "941-922-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM H PETTIBON PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "PETTIBON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HARRY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "941-922-7574",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "PY6096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.