Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Keith Pettibon, MD

Individual provider Vascular & Interventional Radiology Physician · NPI 1467744573

Keith Pettibon, MD is a Diagnostic Radiology in Fort Worth, Texas. Qualified in 2011, 15 years ago. Practices with Ochsner Clinic LLC, a 2,842-clinician group. Licensed in Texas.

Years since qualifying
15
Licensed in
TX
In the registry since
2011
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

815 Pennsylvania Ave
Fort Worth, TX 76104
Phone: (817) 321-0404
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence R1614 (TX)
Vascular & Interventional Radiology Physician Taxonomy 2085R0204X · Licence R1614 (TX)

Record details

NPI number1467744573
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMay 7, 2011
Last updated in NPPESJune 13, 2024
Certification dateJune 13, 2024
Mailing address816 W Cannon St, Fort Worth, TX 76104-3146

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Ochsner Clinic Llc — 2842 clinicians
Accepts Medicare assignment Not indicated
Practice locations5 on file with Medicare

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