Individual
DR. GARY J. PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1540 SPRING VALLEY DRIVE, HUNTINGTON, WV 25704
(304) 429-6741
(304) 429-0262
Mailing address
1540 SPRING VALLEY DRIVE, HUNTINGTON, WV 25704
(304) 429-6741
(304) 429-0262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036118847
IL
207Q00000X
Family Medicine Physician
Primary
17521
WV
207Q00000X
Family Medicine Physician
35-07-5727
OH
207Q00000X
Family Medicine Physician
50755020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000593893
ANTHEM
OH
01
—
000000699790
ANTHEM
OH
05
—
1804764000
—
OH
05
—
2255250
—
OH
01
—
P00693880
RRMCR
OH
Enumeration date
03/14/2006
Last updated
02/24/2025
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