Provider Demographics
NPI:1124020169
Name:PETRO, JOHN VERNON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VERNON
Last Name:PETRO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:102 E HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1310
Mailing Address - Country:US
Mailing Address - Phone:601-268-5144
Mailing Address - Fax:601-268-5179
Practice Address - Street 1:102 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1310
Practice Address - Country:US
Practice Address - Phone:601-268-5144
Practice Address - Fax:601-268-5149
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS09169207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0115554Medicaid
MSBP1817165OtherDEA
MS0115554Medicaid