DR. EDWARD WALTER PETTYJOHN (NPI# 1801228630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801228630 |
| Entity Type | Individual |
| Full Name | DR. EDWARD WALTER PETTYJOHN |
| Credential | M.D. |
| Practice Address |
18626 Hardy Oak Blvd Ste 300 San Antonio TX 78258-4228 |
| Practice Telephone | 2104959047 |
| Practice Fax Number | 2102932772 |
| Mailing Telephone | 2104959047 |
| Mailing Fax Number | 2102932772 |
| Enumeration Date | 2013-08-03 |
| Last Update Date | 2020-08-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | S1430 | TX | Allopathic & Osteopathic Physicians |
| N | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
S1430 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 400888001 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 782584228 | 2104959047 | 2104959310 |
| 251 Cully Dr Ste A, Kerrville, TX 780286084 | 2104959047 | 2102932772 |
| Street Address |
18626 HARDY OAK BLVD STE 300 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78258-4228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598764813 | Gregg S Gurwitz | Orthopaedic Surgery | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2005-07-19 |
| 1528557360 | Jane Lawhon Simmons | Counselor | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2018-05-08 |
| 1245753730 | Annette Jo Gantz | Nurse Practitioner | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2017-07-17 |
| 1518397322 | South Texas Spinal Clinic, P.a. | Durable Medical Equipment & Medical Supplies | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2013-11-14 |
| 1033445333 | Jose E. Fuentez, Jr. | Physician Assistant | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2009-10-22 |
| 1275732166 | Ralph Zachary Garza | Orthopaedic Surgery | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2007-07-12 |
| 1851302798 | Timothy S Metcalf | Physician Assistant | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2006-08-09 |
| 1679506653 | South Texas Spinal Clinic, P.a. | Orthopaedic Surgery | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2006-07-10 |
| 1497796643 | Ajeya Padmakar Joshi | Orthopaedic Surgery | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2006-06-09 |
| 1457329906 | Joel W. Jenne | Orthopaedic Surgery | 18626 Hardy Oak Blvd Ste 300, San Antonio, TX 78258-4228 | 2006-03-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356980163 | Jeffrey M. Martinez, M.d., P.a. | Surgery | 525 Centre Oak Drive, Suite 140, San Antonio, TX 78258 | 2019-12-26 |
| 1588226211 | New Life Brace and Limb, LLC | Prosthetist | 300 E. Sonterra Blvd., Suite 220, San Antonio, TX 78258 | 2019-07-02 |
| 1720649080 | Miguel Ibarra | Pharmacist | 18866 Stone Oak Pkwy., St.101, San Antonio, TX 78258 | 2019-06-26 |
| 1528538113 | Kevin Scott Farnsworth | Dentist | 1130 E. Sonterra Blvd Suite 100, San Antonio, TX 78258 | 2018-11-27 |
| 1891262176 | Dentists of Stone Oak, PC | Dentist | 23714 Hardy Oak Blvd, Suite 110, San Antonio, TX 78258 | 2018-10-25 |
| 1003399437 | Jesus Alcala | Physical Therapist | 20821 Us Hwy 281 N, Ste 110, San Antonio, TX 78258 | 2018-09-11 |
| 1184106544 | Marissa Kaye Bruton | Occupational Therapist | 505 Madison Oak, San Antonio, TX 78258 | 2018-09-02 |
| 1508346933 | Desiree Carroll | Occupational Therapy Assistant | 18803 Hardy Oak Drive, San Antonio, TX 78258 | 2018-08-15 |
| 1700376456 | Conner Jay Mcnabb | Optometrist | 810 Knights Cross Dr Ste 101, San Antonio, TX 78258 | 2018-05-17 |
| 1982191516 | Freehand Solutions LLC | Chiropractor | Nec Stone Oak Parkway & Loop 1604, San Antonio, TX 78258 | 2018-04-19 |
| Find all providers in zip 78258 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| 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 Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457998494 | Texas Oaks Orthopaedic and Sports Medicine Institute, P.a. | Orthopaedic Surgery | 12103 Huebner Rd, San Antonio, TX 78230-5000 | 2019-12-10 |
| 1679031777 | Nix Physicians Inc. | Orthopaedic Surgery | 414 Navarro St Ste 1128, San Antonio, TX 78205-2558 | 2019-03-07 |
| 1477028223 | Schulze Orthopedics | Orthopaedic Surgery | 8715 Village Dr Ste 600, San Antonio, TX 78217-5407 | 2018-10-09 |
| 1265810725 | Cody J Covington | Orthopaedic Surgery | 11212 Tx-hwy 151, Medical Plaza I, Suite 310, San Antonio, TX 78251 | 2015-05-15 |
| 1932516630 | Orlando David Sabbag Daccarett | Orthopaedic Surgery | 19026 Ridgewood Pkwy Ste 311, San Antonio, TX 78259-5502 | 2014-07-15 |
| 1578980660 | Chance Cameron Moore | Orthopaedic Surgery | 2833 Babcock Road, Tower II, Suite 435, San Antonio, TX 78229-3901 | 2014-03-26 |
| 1144664962 | Raymond Evan Skunda | Orthopaedic Surgery | 6800 W Ih 10 Ste 250, San Antonio, TX 78201 | 2013-04-23 |
| 1851688758 | Nicholas Edward Gerken | Orthopaedic Surgery | 1139 E Sonterra Blvd Ste 401, San Antonio, TX 78258-4987 | 2011-06-30 |
| 1316244023 | Patrick M. Palmer, Md, Pa | Orthopaedic Surgery | 540 Madison Oak Drive, Suite 500, San Antonio, TX 78258 | 2011-02-15 |
| 1790080109 | Roger J Lunke Md Pa | Orthopaedic Surgery | 540 Madison Oak Dr Ste 350, San Antonio, TX 78258-3921 | 2011-01-14 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78258 |
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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.