CHARLES ROBERT PETTIT MD A MEDICAL CORPORATION (NPI# 1316268386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316268386 |
| Entity Type | Organization |
| Organization Name | CHARLES ROBERT PETTIT MD A MEDICAL CORPORATION |
| Practice Address |
175 Concourse Blvd Santa Rosa CA 95403-8217 |
| Mailing Address |
3906 Heathfield Pl Santa Rosa CA 95404-7627 |
| Practice Telephone | 7072849200 |
| Practice Fax Number | 7072849204 |
| Mailing Telephone | 7078433999 |
| Mailing Fax Number | 7075453999 |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2015-08-14 |
| Authorized Official Name | DR. CHARLES ROBERT PETTIT (PRESIDENT) |
| Authorized Official Telephone | 7078433999 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
175 CONCOURSE BLVD |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95403-8217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447303441 | Frank Ray Wilbur | Chiropractor | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2007-01-21 |
| 1922624113 | Andrea Mazzola | Naturopath | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2020-06-23 |
| 1972169480 | Integrated Diabetes Solutions A Professional Nursing Corporation | Clinic/Center | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2019-05-10 |
| 1427489277 | Barbara Birsinger | Dietitian, Registered | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2013-12-04 |
| 1912246760 | Pamela Susan Koppel | Social Worker | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2013-02-13 |
| 1073879292 | Dana Shelley Michaels | Naturopath | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2012-04-02 |
| 1932395563 | Victoria Georgia Landes | Social Worker | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2007-09-18 |
| 1548314446 | Robert Bruce Dozor | General Practice | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2007-01-22 |
| 1184778094 | Ellen Barnett | General Practice | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2007-01-22 |
| 1619021433 | Moses David E Goldberg | Naturopath | 175 Concourse Blvd, Santa Rosa, CA 95403-8217 | 2007-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912549841 | Abundance Acupuncture Healing Clinic | Acupuncturist | 3410 Mendocino Avenue, Santa Rosa, CA 95403 | 2019-10-11 |
| 1982161337 | Crystal J Ward | Registered Nurse | 2350 Mendocino Ave, Ste A4, Santa Rosa, CA 95403 | 2019-02-21 |
| 1033674379 | George Edward Griese | Respiratory Therapist, Registered | 501 Bicentennial Way, Santa Rosa, CA 95403 | 2019-01-31 |
| 1508320672 | East-west Natural Medicine Inc. | Acupuncturist | 2200 Range Ave #207, Santa Rosa, CA 95403 | 2019-01-23 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1326519182 | Jkb Solutions Inc. | In Home Supportive Care | 3554 Round Barn Boulevard, Suite 311, Santa Rosa, CA 95403 | 2018-12-05 |
| 1487121265 | Catholic Charities of The Diocese of Santa Rosa | Clinic/Center | 987 Airway Ct, Santa Rosa, CA 95403 | 2018-10-30 |
| 1447746524 | Lisa Jean Quang | Optometrist | 3925 Old Redwood, Medical Office Building 4, Suite 141, Santa Rosa, CA 95403 | 2018-07-02 |
| 1598253353 | Jennifer Renee Lummus | Community Health Worker | 3614 Condo Court, Santa Rosa, CA 95403 | 2018-04-27 |
| 1871042366 | Sadie Thuet | Marriage & Family Therapist | 3434 A Mendocino Ave, Santa Rosa, CA 95403 | 2016-09-26 |
| Find all providers in zip 95403 | ||||
| Taxonomy Code | 207YX0905X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngology/Facial Plastic Surgery |
| An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417294174 | Entegrative Otolaryngology PC | Otolaryngology | 1144 Sonoma Ave Ste 101, Santa Rosa, CA 95405-4812 | 2013-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073159406 | Bh Ent Group Inc | Otolaryngology | 9033 Wilshire Blvd Ste 409, Beverly Hills, CA 90211-1847 | 2019-11-20 |
| 1942719570 | Beverly Hills Head and Neck Associates | Otolaryngology | 9401 Wilshire Blvd Ste 650, Beverly Hills, CA 90212-2913 | 2017-09-27 |
| 1083135065 | Jeffrey Jumaily Md Inc | Otolaryngology | 8816 Burton Way # 1, Beverly Hills, CA 90211-1715 | 2017-06-29 |
| 1558881771 | Bel Air Surgical Institute | Otolaryngology | 11847 Wilshire Blvd Ste 302, Los Angeles, CA 90025-6634 | 2017-06-20 |
| 1912371352 | Ent Surgical Specialists Inc. | Otolaryngology | 6424 W Olympic Blvd, Los Angeles, CA 90048-5347 | 2015-11-23 |
| 1437536216 | Kiersten L. Riedler | Otolaryngology | 5405 Oberlin Dr Fl 2, San Diego, CA 92121-1700 | 2015-04-30 |
| 1114344025 | Ryan M Casserly | Otolaryngology | 966 Cass St Ste 250, Monterey, CA 93940-4541 | 2014-03-28 |
| 1558798611 | Stephen Dow Proffitt | Otolaryngology | 172 Admiral Way, Costa Mesa, CA 92627-1397 | 2013-10-03 |
| 1447693973 | Jacob Lee Wester | Otolaryngology | 200 Medical Plaza Driveway Ste 550, Ucla Department of Head and Neck Surgery, Los Angeles, CA 90095-0001 | 2013-04-15 |
| 1396002606 | Michael Hall | Otolaryngology | 355 Lennon Ln Ste 235, Walnut Creek, CA 94598-2544 | 2012-04-12 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA |
| Zip Code | 95403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.