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Individual
DR. GARY J. PETTY
Active
Individual
DR. GARY J. PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036118847
IL
207Q00000X
Family Medicine Physician
Primary
17521
WV
207Q00000X
Family Medicine Physician
35-07-5727
OH
207Q00000X
Family Medicine Physician
50755020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000593893
ANTHEM
OH
01
—
000000699790
ANTHEM
OH
05
—
1804764000
—
OH
05
—
2255250
—
OH
01
—
P00693880
RRMCR
OH
Enumeration date
03/14/2006
Last updated
02/24/2025
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