Provider Demographics
NPI:1427082346
Name:PETTIS, ROBERT M (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:PETTIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1229 C AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4298
Mailing Address - Country:US
Mailing Address - Phone:641-672-3394
Mailing Address - Fax:641-672-3336
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4298
Practice Address - Country:US
Practice Address - Phone:641-672-3394
Practice Address - Fax:949-337-4464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2025-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-55115207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology