Provider Demographics
NPI:1780046276
Name:PETTY, KATE (MD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PARNASSUS AVE, 4TH FLOOR, ROOM 4615
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-476-9035
Mailing Address - Fax:415-353-9613
Practice Address - Street 1:521 PARNASSUS AVE, 4TH FLOOR, ROOM 4615
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-476-9035
Practice Address - Fax:415-353-9613
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65254207L00000X, 1835P0018X, 207LC0200X
PAMD472549207LC0200X
CAA185984207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP300461549404OtherDRIVER LICENSE