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General NPI Number Information
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NPI Number | 1942279013
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Entity Type | Individual
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Provider Name | GARY J. PETTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1540 SPRING VALLEY DRIVE
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City | HUNTINGTON
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State | WV
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Zip | 25704
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Country | US
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Telephone | 304-429-6741
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Fax | 304-429-0262
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Provider Business Mailing Address
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Address Line | 1540 SPRING VALLEY DRIVE
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City | HUNTINGTON
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State | WV
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Zip | 25704
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Country | US
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Telephone | 304-429-6741
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Fax | 304-429-0262
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-07-5727
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036118847
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 50755020
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17521
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License Number State | WV
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