Provider Demographics
NPI:1972581254
Name:PETTEY, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PETTEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7490
Mailing Address - Country:US
Mailing Address - Phone:859-234-1707
Mailing Address - Fax:859-234-1768
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:SUITE 1D
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-234-1707
Practice Address - Fax:859-234-1768
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2015-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY27915207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100041310Medicaid