Individual
DR. CORWIN D PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3201 S MARKET ST STE 105, ROGERS, AR 72758-8168
(479) 254-1005
(479) 668-4003
Mailing address
3201 S MARKET ST STE 105, ROGERS, AR 72758-8168
(479) 254-1005
(479) 668-4003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-2717
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142693001
—
AR
01
—
5C680
BLUE CROSS BLUE SHIELD
AR
01
—
5L696
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/26/2005
Last updated
04/04/2018
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