# DR. GARY J. PETTY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1942279013
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 036118847 | IL | — |
| 207Q00000X | Family Medicine Physician | 17521 | WV | Yes |
| 207Q00000X | Family Medicine Physician | 35-07-5727 | OH | — |
| 207Q00000X | Family Medicine Physician | 50755020 | WI | — |

## Other

- **Enumeration date:** 03/14/2006
- **Last updated:** 02/24/2025

## 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 |