Organization
GARY M PETRUS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY MICHAEL PETRUS MD (PRESIDENT)
(501) 758-9800
Entity
Organization
Contact information
Practice address
2504 MCCAIN BLVD, SUITE 114, NORTH LITTLE ROCK, AR 72116-7624
(501) 758-9800
(501) 758-0199
Mailing address
2504 MCCAIN BLVD, SUITE 114, NORTH LITTLE ROCK, AR 72116-7624
(501) 758-9800
(501) 758-0199
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
C7318
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114482001
—
AR
05
—
122380002
—
AR
Enumeration date
11/15/2006
Last updated
01/28/2011
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