Russell Petty, MD is a
Family Medicine physician based in Cando, North Dakota. Russell Petty is licensed to practice in North Dakota (license number 3895) and his current practice location is Highway 281 North, Cando, North Dakota. He can be reached at his office (for appointments etc.) via phone at
(701) 968-2541.
NPI number for Russell Petty is 1043245277 and his current mailing address is Po Box 688, Cando, North Dakota. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1043245277.
Physician's Profile
| Full Name | Russell Petty |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | Highway 281 North, Cando, North Dakota |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1043245277
- Provider Enumeration Date: 07/12/2006
- Last Update Date: 07/09/2007
Medical Identifiers
Medical identifiers for Russell Petty such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1043245277 | NPI | - | NPPES |
| 12622 | Medicaid | ND | |
| 21510 | Other | ND | BCBS PROVIDER # |
| 24029 | Other | ND | BCBS PROVIDER # |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 3895 (North Dakota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Russell Petty is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Russell Petty, MD
Po Box 688,
Cando, ND 58324-0688
Ph: (701) 968-2541 | Russell Petty, MD
Highway 281 North,
Cando, ND 58324-0688
Ph: (701) 968-2541 |
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