Provider Demographics
NPI:1144746249
Name:JAN H. PETRI MD, PLLC
Entity Type:Organization
Organization Name:JAN H. PETRI MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-861-2526
Mailing Address - Street 1:9554 FOX HILL CIR S
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6829
Mailing Address - Country:US
Mailing Address - Phone:901-485-0863
Mailing Address - Fax:
Practice Address - Street 1:2028 W POPLAR AVE STE 112
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-861-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty