Individual
JOSEPH LEE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
928 N GLENWOOD BLVD, TYLER, TX 75702-5055
(903) 535-9041
(903) 533-0726
Mailing address
523 S FANNIN AVE, TYLER, TX 75702-8204
(903) 535-9041
(903) 747-8163
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
N6579
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215374402
—
TX
01
—
295206101
MEDICAID GROUP NUMBER
TX
01
—
TXB102462
MEDICARE GROUP PTAN
TX
01
—
TXB146789
MEDICARE PTAN
TX
Enumeration date
08/07/2007
Last updated
01/18/2023
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