Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD-061603 | PA |
NPI | 1093024697 |
---|---|
Provider Name | Kevin Petty |
First Address | Lansdale, PA 19446-4455 |
Second Address | Lansdale, PA 19446-4455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 29/09/2010 |