Basic Information
| Provider Information | |||||||||
| NPI: | 1043239684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETRY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2173 | ||||||||
| Address2: | |||||||||
| City: | SKYLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287762173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752625 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 SCHNIER ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472012619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123783131 | ||||||||
| FaxNumber: | 8123799251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | 01027846A | IN | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207KI0005X | 01027846A | IN | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Clinical & Laboratory Immunology | 207K00000X | 01027846A | IN | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.