Provider Demographics
NPI:1053162271
Name:PETRAS, DAVID JAMES
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:PETRAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 REEDS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1386
Mailing Address - Country:US
Mailing Address - Phone:757-677-6050
Mailing Address - Fax:866-408-0670
Practice Address - Street 1:221 1ST AVE W STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4223
Practice Address - Country:US
Practice Address - Phone:757-677-6050
Practice Address - Fax:866-408-0670
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies