Provider Demographics
NPI:1376877795
Name:PETTY, DAVID AARON (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:AARON
Last Name:PETTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 S 15TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8262
Mailing Address - Country:US
Mailing Address - Phone:208-529-9292
Mailing Address - Fax:208-523-2397
Practice Address - Street 1:3422 S 15TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8262
Practice Address - Country:US
Practice Address - Phone:208-529-9292
Practice Address - Fax:208-523-2397
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002408207KA0200X
IDO-0796207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy