Individual
DR. JARED B PETTY
Active
Individual
DR. JARED B PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M7519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206328102
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
7527715699005
TRICARE
TX
01
—
8DB900
BCBS
TX
01
—
8V3853
BCBS
TX
01
—
TIN PLUS 083
TRICARE
TX
Enumeration date
06/01/2007
Last updated
03/03/2025
Update your record
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