Robert M Pettis MD Inc.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

A77461 Issued in CA

Legal business name

ROBERT M PETTIS MD INC.

Practice address

31862 Coast Hwy Ste 302
Laguna Beach, CA 92651-6772

Phone

(949) 715-0500

NPI assigned

Feb 2, 2007

Last updated

Jul 28, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert M Pettis, MD

Title

President

Phone

(949) 715-0500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dimitry B Goufman, M.D.

  • Otolaryngology Physician
  • Orange, CA
  • NPI 1104824101
  NPD (past)

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1336287036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7630",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926077630",
            "telephone_number": "949-643-3345",
            "fax_number": "949-643-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31862 COAST HWY STE 302",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926516772",
            "telephone_number": "949-715-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT M PETTIS MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "PETTIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-715-0500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A77461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A77461",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rieschick Anesthesia Services Inc
• Judith Rigby, M.D.
• Right Recovery Inc
• Kimberly Roberson, LCSW
• Robert L Woods MD Inc
• Elijah James Robinson
• Jenna Robinson
• Jacqueline Itzel Rodriguez Prado
• Myriam Rebecca Rodriguez
• Sofia Rodriguez, DDS

• Otolaryngology Physician in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.