Individual
HENRY D. PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
931 E 32ND ST, JOPLIN, MO 64804-2808
(417) 347-4374
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-4374
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
31192
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240027425
—
MO
Enumeration date
12/08/2005
Last updated
08/31/2011
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