Individual
JOHN K PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-6637
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-6637
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
200501628
NC
2086S0102X
Surgical Critical Care Physician
200501628
NC
2086S0120X
Pediatric Surgery Physician
200501628
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10211484
—
VA
01
—
14042
BCBS
—
01
—
184276
MEDCOST
—
05
—
3810003638
—
WV
05
—
5902325
—
NC
01
—
7290767
AETNA
—
01
—
806729
PARTNERS
—
05
—
Q01623
—
SC
Enumeration date
12/16/2005
Last updated
11/12/2010
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