National Provider Identifier Database

KEITH PETTIBON, MD – NPI #1467744573
Diagnostic Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.


Contact Information

KEITH PETTIBON, MD
815 PENNSYLVANIA AVE
FORT WORTH, TX76104
Phone: 817-321-0404
Fax:
Website:
Specialty Taxonomy Code
* Diagnostic Radiology 2085R0202X
Vascular & Interventional Radiology 2085R0204X

* Indicates primary specialty

NPI Profile & details for KEITH PETTIBON

NPI Number 1467744573
Credentials MD
Entity Individual
Enumeration date 05/07/2011
Last updated 06/13/2024 - More than a year ago
Sole proprietor1 Yes
Identifiers
  • TX License #: R1614
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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