Individual
DR. JARED B PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
209 E BROADWAY ST, WINNSBORO, TX 75494-2604
(903) 342-3355
Mailing address
209 E BROADWAY ST, WINNSBORO, TX 75494-2604
(903) 342-3355
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
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