Individual
THOMAS PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3750 LANDMARK DR, SUITE A, LAFAYETTE, IN 47905-6633
(765) 448-4511
(765) 447-8375
Mailing address
3750 LANDMARK DR, SUITE A, LAFAYETTE, IN 47905-6633
(765) 448-4511
(765) 447-8375
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01039821
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100103400
—
IN
Enumeration date
11/01/2006
Last updated
10/15/2014
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