Jan H Petri, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

17612 Issued in TN

Practice address

2028 W Poplar Ave Ste 112
Collierville, TN 38017-0618

Phone

(901) 861-2526

Fax

(901) 861-2527

NPI assigned

Apr 24, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1033175682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9554 FOX HILL CIR S",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381396829",
            "telephone_number": "901-861-2526",
            "fax_number": "901-861-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 W POPLAR AVE STE 112",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380170618",
            "telephone_number": "901-861-2526",
            "fax_number": "901-861-2527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5625 Poplar Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381193816",
            "country_code": "US",
            "telephone_number": "901-761-1220",
            "fax_number": "901-763-4332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRI",
        "first_name": "JAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TN",
            "license": "17612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3073227",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Collierville, TN
• Providers in Collierville, TN by specialty
• Otolaryngology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.