Individual
WILLIAM C PETTY
Active
Individual
WILLIAM C PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01038794
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092611
ANTHEM
IN
01
—
1696
PHP
IN
05
—
2100621
—
OH
05
—
4074933100
—
MI
Enumeration date
05/17/2006
Last updated
07/08/2007
Update your record
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