MEDICARE: DR. JAMES PETTEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	27915	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972581254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PETTEY MD

Provider Business Mailing Address
First Line	:	1210 KY HIGHWAY 36 E
Second Line	:	SUITE 1D
City	:	CYNTHIANA
State	:	KY
Zip	:	41031-7490
Country	:	US
Telephone Number	:	859-234-1707
Fax Number	:	859-234-1768

Provider Business Practice Location Address
First Line	:	1210 KY HIGHWAY 36 E
Second Line	:	SUITE 1D
City	:	CYNTHIANA
State	:	KY
Zip	:	41031-7490
Country	:	US
Telephone Number	:	859-234-1707
Fax Number	:	859-234-1768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/18/2015

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