Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 01027846A | IN |
N | 207KA0200X | Allergist | 01027846A | IN |
NPI | 1043239684 |
---|---|
Provider Name | Dr. Robert W Petry |
First Address | Skyland, NC 28776-2173 |
Second Address | Columbus, IN 47201-2619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 12/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C24190 | (02) | IN |