Individual
DR. GARY LEE PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1110 COLUMBINE DRIVE, HOLTON, KS 66436
(785) 364-2126
(785) 364-2801
Mailing address
1110 COLUMBINE DRIVE, HOLTON, KS 66436
(785) 364-2126
(785) 364-2801
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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