DR. THEODORE G PETTLE (NPI# 1003102211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1003102211 |
Entity Type | Individual |
Full Name | DR. THEODORE G PETTLE |
Credential | MD |
Practice Address |
1700 Se Hillmoor Dr Port St Lucie FL 34952-7539 |
Practice Telephone | 7723359600 |
Mailing Telephone | 7723359600 |
Enumeration Date | 2011-06-27 |
Last Update Date | 2020-09-14 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
ME139195 | FL | Allopathic & Osteopathic Physicians |
N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
R6457 | TX | Allopathic & Osteopathic Physicians |
Street Address |
1700 SE HILLMOOR DR |
City | PORT ST LUCIE |
State | FL |
Zip Code | 34952-7539 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619969573 | William A Stolzer | Orthopaedic Surgery | 1700 Se Hillmoor Dr, Suite 500, Port St Lucie, FL 34952-7536 | 2005-08-17 |
1639722176 | Naomi Blake | Counselor | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2019-07-23 |
1255864468 | Phillip Saeho Son | Student in an Organized Health Care Education/Training Program | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2017-04-05 |
1245763424 | Abby Regan | Student in an Organized Health Care Education/Training Program | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2017-04-05 |
1619330537 | Hemal Patel | Family Medicine | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2016-03-29 |
1194110304 | Mariana Giron | Family Medicine | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2015-04-03 |
1699168864 | Emily Sou | Pediatrics | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2015-03-12 |
1710395835 | Natasha Williamson Jones | Nurse Practitioner | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2014-08-01 |
1902230477 | Cindy Yuen | Family Medicine | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952 | 2013-09-02 |
1285973107 | William Winston Leonard Peterson IIi | Chiropractor | 1700 Se Hillmoor Dr, Ste 502, Port St Lucie, FL 34952-7566 | 2013-02-13 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215587068 | Carehere LLC | Family Medicine | Carehere Clinic- St. Lucie Psl, 1680 Se Lyngate Drive, Port St Lucie, FL 34952 | 2019-09-13 |
1255998274 | Morningside Alf | Assisted Living Facility | 2233 Se Mroningside Alf, Port Saint Lucie, FL 34952 | 2019-05-24 |
1336611870 | Med Braces and Supplies, LLC | Durable Medical Equipment & Medical Supplies | 1484 Se Village Green Dr, Port St Lucie, FL 34952 | 2018-12-21 |
1689143794 | The Gift of Recovery, LLC | Counselor | 1801 Sw Hillmoor Drive, Suite C-101, Port St. Lucie, FL 34952 | 2018-11-19 |
1457830853 | Cathy L Sonier | Counselor | 357 Brazilian Circle, Port St Lucie, FL 34952 | 2018-08-07 |
1548756661 | Blo 7 Diabetes Institute Inc | Nutritionist | 1700 Sw Hillmoor Dr., Suite 305, Port St. Lucie, FL 34952 | 2018-07-02 |
1780194464 | Doctor's Choice Medical Center | Clinic/Center | 9164 S Us Highway 1, Port St Lucie, FL 34952 | 2017-10-06 |
1801305644 | Thandiwe Daley | Behavior Technician | 1935 Se Hillmoor Drive, Apt#159, Port St Lucie, FL 34952 | 2017-09-25 |
1700309408 | Lagrand Evan Andrews | Assistant Behavior Analyst | 265 Se Lenard Rd. Apartment 307, Port St. Lucie, FL 34952 | 2017-07-25 |
1578085148 | Lavetta S Ivey | Behavior Technician | 7190 Us Federal Hwy 1, Port Saint Lucie, FL 34952 | 2017-07-14 |
Find all providers in zip 34952 |
Taxonomy Code | 207RG0100X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Gastroenterology |
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346453610 | Scott E Altschuler | Internal Medicine | 1701 Se Hillmoor Dr Ste 4, Port St Lucie, FL 34952-7552 | 2007-05-07 |
1568416030 | Jayshree Matadial | Internal Medicine | 501 Nw Lake Whitney Pl Ste 102, Port St Lucie, FL 34986-1615 | 2006-05-20 |
1316922511 | Khiem Nguyen | Internal Medicine | 1822 Se Port St Lucie Blvd, Port St Lucie, FL 34952-5545 | 2005-12-09 |
1881115343 | Treasure Coast Gi LLC | Internal Medicine | 1701 Se Hillmoor Dr Ste 4, Port St Lucie, FL 34952-7552 | 2017-07-05 |
1477888444 | Gastroenterology Specialist of The Treasure Coast, Inc | Internal Medicine | 501 Nw Lake Whitney Pl Ste 102, Port St Lucie, FL 34986-1615 | 2009-10-08 |
1518128438 | St. Lucie Gastrointestinal Diseases Pl | Internal Medicine | 1822 Se Port St Lucie Blvd, Port St Lucie, FL 34952-5545 | 2008-06-23 |
1053325118 | Celso E Pineiro | Internal Medicine | 1651 Se Tiffany Ave, Port St Lucie, FL 34952-7564 | 2006-07-27 |
1043239866 | Edwin D. Flanagan | Internal Medicine | 1651 Se Tiffany Ave, Port St Lucie, FL 34952-7564 | 2006-07-19 |
1912940479 | Kenneth R Kohen | Internal Medicine | 1651 Se Tiffany Ave, Port St Lucie, FL 34952-7564 | 2006-06-13 |
1265490163 | Steven M Kappler | Internal Medicine | 1651 Se Tiffany Ave, Port St Lucie, FL 34952-7564 | 2006-05-02 |
Find all providers in PORT ST LUCIE |
City | PORT ST LUCIE |
Zip Code | 34952 |
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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.