Individual
MR. GARY MICHAEL PETRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4137 JOHN F KENNEDY BLVD STE A, N LITTLE ROCK, AR 72116-8230
(501) 614-3052
(501) 614-3057
Mailing address
PO BOX 241580, LITTLE ROCK, AR 72223-0011
(501) 614-3052
(501) 614-3057
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
C7318
AR
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
C7318
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114482001
—
AR
Enumeration date
12/18/2006
Last updated
01/25/2019
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