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Individual

DR. GLENN G PETTY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
5510 SUMMERHILL RD, TEXARKANA, TX 75503-1822
(903) 792-2710
(903) 831-7357
Mailing address
PO BOX 6579, TEXARKANA, TX 75505-6579
(870) 863-7080
(903) 792-3286

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
180
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
018576101
TX
05
134175717
AR
01
P00129576
RAILROAD-AR
AR
01
P00349253
RAILROAD-TX
TX
Enumeration date
06/16/2006
Last updated
08/05/2008
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