Corwin D. Petty, Md, Pa | |
3201 S Market St Ste 105 Rogers AR 72758-8168 | |
(479) 254-1005 | |
(479) 668-4003 |
Full Name | Corwin D. Petty, Md, Pa |
---|---|
Speciality | Family Medicine |
Location | 3201 S Market St Ste 105, Rogers, Arkansas |
Authorized Official Name and Position | Corwin D Petty (OWNER / PHYSICIAN) |
Authorized Official Contact | 4792541005 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Corwin D. Petty, Md, Pa 3201 S Market St Ste 105 Rogers AR 72758-8168 Ph: (479) 254-1005 | Corwin D. Petty, Md, Pa 3201 S Market St Ste 105 Rogers AR 72758-8168 Ph: (479) 254-1005 |
NPI Number | 1881859593 |
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Provider Enumeration Date | 07/22/2008 |
Last Update Date | 04/04/2018 |
Medicare PECOS PAC ID | 2567530702 |
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Medicare Enrollment ID | O20081001000447 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881859593 | NPI | - | NPPES |
5C680 | Other | AR | BLUE CROSS BLUE SHIELD |
149427002 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Corwin D Petty |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1295735959 PECOS PAC ID: 8628080967 Enrollment ID: I20060703000055 |
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