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Organization
CORWIN D. PETTY, MD, PA
Active
Organization
CORWIN D. PETTY, MD, PA
Active
Parent organization
PETTY MEDICAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETTY MEDICAL CLINIC
Authorized official
DR. CORWIN D PETTY MD (OWNER / PHYSICIAN)
(479) 254-1005
Entity
Organization
Contact information
Practice address
3201 S MARKET ST STE 105, ROGERS, AR 72758-8168
(479) 254-1005
(479) 668-4003
Mailing address
3201 S MARKET ST STE 105, ROGERS, AR 72758-8168
(479) 254-1005
(479) 668-4003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149427002
—
AR
01
—
5C680
BLUE CROSS BLUE SHIELD
AR
Enumeration date
07/22/2008
Last updated
04/04/2018
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