Organization
CORWIN D. PETTY, MD, PA
Active
Parent organization
PETTY MEDICAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETTY MEDICAL CLINIC
Authorized official
DR. CORWIN D PETTY MD (OWNER / PHYSICIAN)
(479) 254-1005
Entity
Organization
Contact information
Practice address
3201 S MARKET ST STE 105, ROGERS, AR 72758-8168
(479) 254-1005
(479) 668-4003
Mailing address
3201 S MARKET ST STE 105, ROGERS, AR 72758-8168
(479) 254-1005
(479) 668-4003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149427002
—
AR
01
—
5C680
BLUE CROSS BLUE SHIELD
AR
Enumeration date
07/22/2008
Last updated
04/04/2018
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