Petrus, Gary Michael

Petrus, Gary Michael is an individual health care provider with primary practice located at 4137 John F Kennedy Blvd Ste A , N Little Rock AR 72116-8230. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic Surgery Within the Head and Neck, Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery is his primary health care specialty. Petrus, Gary Michael can be contacted via phone (501) 614-3052.

Contact Information

Primary practice address
4137 John F Kennedy Blvd Ste A N Little Rock AR 72116-8230
Phone: (501) 614-3052
Fax: (501) 614-3057
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery Within the Head and Neck 2082S0099X C7318 Arkansas
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X C7318 Arkansas

Profile Details

NPI number 1568525806
LBN Legal business name Petrus, Gary Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 18th, 2006
Last updated Jan 25th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568525806 NPPES
Arkansas MEDICAID 114482001

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