Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 03666 | KY |
N | 111NI0900X | Internist | 03666 | KY |
N | 207R00000X | Internist | 2013015508 | MO |
N | 111NI0900X | Internist | 2013015508 | MO |
N | 207R00000X | Internist | DO2344 | TN |
N | 111NI0900X | Internist | DO2344 | TN |
N | 207RA0401X | Internist - Addiction Medicine | 03666 | KY |
Y | 207RC0200X | Critical Care Medicine | 2013015508 | MO |
N | 207RI0200X | Infectious Disease | 05-37065 | KS |
NPI | 1245551795 |
---|---|
Provider Name | Dr. Christopher L Petrey |
First Address | Danville, KY 40423-0990 |
Second Address | Springfield, MO 65804-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 20/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | AR |
PENDING | (05) | MO |
PENDING | (05) | OK |