Provider Demographics
NPI:1982050126
Name:PETTY, LLOYD (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:
Last Name:PETTY
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N 2030 E RM 2110
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5339
Mailing Address - Country:US
Mailing Address - Phone:801-585-3353
Mailing Address - Fax:
Practice Address - Street 1:15 N 2030 E RM 2110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5339
Practice Address - Country:US
Practice Address - Phone:801-585-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2226-19207R00000X
UT11605065-1204207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine