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Individual
DR. GARY LEE PETRY
Active
Individual
DR. GARY LEE PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0428470
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10039800A
—
KS
01
—
101003
BCBS
KS
01
—
80175101
RR MEDICARE
KS
Enumeration date
09/28/2006
Last updated
11/25/2020
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