Active NPI
Larry D. Petty, MD
- Anesthesiology Physician
- San Angelo, TX
National Provider Identifier
1578526331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- D2555
- Practice address
- 120 E Beauregard Ave
San Angelo, TX 76903-5919 - Phone
- (325) 658-1511
- NPI assigned
- Apr 11, 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | D2555 | TX | Primary |
Addresses
Primary practice location
120 E Beauregard Ave
San Angelo, TX 76903-5919
Mailing address
PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 658-1511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 126210105 | Medicaid | TX |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375056000000",
"number": "1578526331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22000",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769027200",
"telephone_number": "325-658-1511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 E BEAUREGARD AVE",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769035919",
"telephone_number": "325-658-1511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "LARRY",
"middle_name": "D.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-11",
"last_updated": "2013-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "TX",
"license": "D2555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "126210105",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.