Individual
GRANT DOUGLAS PETTY
Active
Individual
GRANT DOUGLAS PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
052617
GA
2085R0202X
Diagnostic Radiology Physician
Primary
22682
WV
2085R0202X
Diagnostic Radiology Physician
35089226
OH
2085R0202X
Diagnostic Radiology Physician
40841
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221879
UNISON
OH
01
—
001962777
MTN ST BCBS
WV
05
—
2732556
—
OH
05
—
3810008705
—
WV
01
—
50017454
PASSPORT
KY
01
—
550493376 00
WV WORKER'S COMPENSATION
WV
05
—
7100014760
—
KY
01
—
7389831
AETNA
—
01
—
P00413759
RR MEDICARE
WV
Enumeration date
08/24/2006
Last updated
05/07/2024
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