Active NPI
Anthony Bedear Petro, M.D.
- Surgery Physician
- Jackson, MS
National Provider Identifier
1487769154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 05828
- Practice address
- 501 Marshall St
Suite 500
Jackson, MS 39202-1651 - Phone
- (601) 948-1411
- Fax
- (601) 948-0090
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 05828 | MS | Primary |
Addresses
Primary practice location
501 Marshall St
Suite 500
Jackson, MS 39202-1651
Mailing address
501 Marshall St
Suite 500
Jackson, MS 39202-1651
Phone (601) 948-1411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000017867 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05828 | MS | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257292800000",
"number": "1487769154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 MARSHALL ST",
"address_2": "SUITE 500",
"city": "JACKSON",
"state": "MS",
"postal_code": "392021651",
"telephone_number": "601-948-1411",
"fax_number": "601-948-0090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 MARSHALL ST",
"address_2": "SUITE 500",
"city": "JACKSON",
"state": "MS",
"postal_code": "392021651",
"telephone_number": "601-948-1411",
"fax_number": "601-948-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRO",
"first_name": "ANTHONY",
"middle_name": "BEDEAR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2009-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MS",
"license": "05828",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000017867",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.