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General NPI Number Information
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NPI Number | 1275514598
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Entity Type | Individual
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Provider Name | GREGORY JOHN PETRIE MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 895 SILVERGLEN WAY
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-5908
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Country | US
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Telephone | 850-287-3254
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Fax |
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Provider Business Mailing Address
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Address Line | 895 SILVERGLEN WAY
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-5908
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Country | US
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Telephone | 850-287-3254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2009-01762
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License Number State | NC
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