Individual
WILLIAM ROBERT PETTEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6100 HARRIS PKWY, #390, FORT WORTH, TX 76132-4124
(817) 370-9011
(817) 346-0380
Mailing address
6100 HARRIS PKWY, #390, FORT WORTH, TX 76132-4124
(817) 370-9011
(817) 346-0380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G8340
TX
208600000X
Surgery Physician
Primary
G8340
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131434601
—
TX
01
—
4254295
AETNA
—
01
—
91159
AETNA
—
Enumeration date
10/12/2005
Last updated
05/08/2024
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