Individual
BENJAMIN MARTIN PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 WILLIAM PENN PLZ, DURHAM, NC 27704-2150
(919) 220-5255
(919) 313-1276
Mailing address
PO BOX 5105, BELFAST, ME 04915-5100
(919) 220-5255
(919) 313-1276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2017-00201
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
2017-00201
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017-00201
NC MEDICAL LICENSE
NC
Enumeration date
06/13/2011
Last updated
04/28/2022
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