DR. WAYMOND JAY PETTIT (NPI# 1679720726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679720726 |
| Entity Type | Individual |
| Full Name | DR. WAYMOND JAY PETTIT |
| Credential | M.D. |
| Practice Address |
3620 S Taylor Rd Decatur IL 62521-9015 |
| Mailing Address |
451 E 1000 N La Porte IN 46350-8638 |
| Practice Telephone | 2174540022 |
| Mailing Telephone | 2197788524 |
| Mailing Fax Number | 2197788534 |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2008-08-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 036051290 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
3620 S TAYLOR RD |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-9015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104883735 | Stephen J Chadwick | Otolaryngology | 101 W Mckinley Ave, Enta Allergy, Head & Neck Institute, Decatur, IL 62522 | 2006-04-27 |
| 1174589634 | Joanne Pham | Otolaryngology | 1600 W Business 380, Suite A, Decatur, TX 76234-3281 | 2006-04-25 |
| 1851356083 | Willis P Callins | Otolaryngology | 4288 Memorial Dr, Ste D, Decatur, GA 30032-1229 | 2006-04-19 |
| 1265413124 | Sage Kinney Copeland | Otolaryngology | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2005-11-08 |
| 1275531907 | Jenny Christine Kim | Otolaryngology | 484 Irvin Ct, Ste 140, Decatur, GA 30030-5406 | 2005-07-07 |
| 1275857542 | Shivan H Amin | Otolaryngology | 2675 N Decatur Rd, Ste 707, Decatur, GA 30033-6131 | 2010-03-16 |
| 1568646842 | Jeffrey Michael Ulis | Otolaryngology | 101 W Mckinley Ave, Decatur, IL 62526-3286 | 2007-12-22 |
| 1538254727 | Charles R. Potter, M.d., L.L.C. | Otolaryngology | 1770 E Lake Shore Dr, Suite 306, Decatur, IL 62521-3832 | 2006-10-04 |
| 1760597363 | Michelle Marie Cullen | Otolaryngology | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2006-08-21 |
| 1528026580 | Terence R Woods | Otolaryngology | 101 W Mckinley Ave, Enta Allergy, Head & Neck Institute, Decatur, IL 62526 | 2006-05-01 |
| Find all providers in DECATUR | ||||
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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.