Bruce A Petitt, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

15378 Issued in AL

Practice address

1060 Fairfax Park
Suite C
Tuscaloosa, AL 35406-2806

Phone

(205) 752-7337

Fax

(205) 752-8013

NPI assigned

Dec 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: drpetitt@westalabamapediatrics.opdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bruce a Petitt M.D. P.C.

  • Pediatrics Physician
  • Tuscaloosa, AL
  • NPI 1013077205
  NPD (past) Authorized official

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292284800000",
    "number": "1811057003",
    "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": {
        "last_name": "PETITT",
        "first_name": "BRUCE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2010-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "15378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF AL",
            "identifier": "051093844",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009921560",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugenia Compton Perry, BCBA
• Veronica Faye Perry, B.A.
• Personal Care Agency
• Dominic Peterson, RKT
• Remona Peterson, MD
• Kristin Marie Pettey, LGSW
• Ronald C Phelps, MD
• Phenomenal Favor Home Health Care LLC
• Phifer Incorporated
• Brittany Phillips

• Pediatrics Physician in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Pediatrics Physician in Alabama

• 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.