Gary M Petrus MD PA

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

C7318 Issued in AR

Legal business name

GARY M PETRUS MD PA

Practice address

2504 McCain Blvd
Suite 114
North Little Rock, AR 72116-7624

Phone

(501) 758-9800

Fax

(501) 758-0199

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gary Michael Petrus, MDNPI 1568525806

Title

President

Phone

(501) 758-9800

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Michael Petrus, MD

  • Plastic and Reconstructive Surgery Physician
  • N Little Rock, AR
  • NPI 1568525806
  Medicare reassignment Authorized official
• Melanie H Smith, M.D.

  • Otolaryngology Physician
  • North Little Rock, AR
  • NPI 1407854151
  NPD (past)
• Michael Robert Wilcox, MD

  • Family Medicine Physician
  • New Prague, MN
  • NPI 1801814504
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1871666446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 MCCAIN BLVD",
            "address_2": "SUITE 114",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167624",
            "telephone_number": "501-758-9800",
            "fax_number": "501-758-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 MCCAIN BLVD",
            "address_2": "SUITE 114",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167624",
            "telephone_number": "501-758-9800",
            "fax_number": "501-758-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY M PETRUS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2011-01-28",
        "status": "A",
        "authorized_official_last_name": "PETRUS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-758-9800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "AR",
            "license": "C7318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114482001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122380002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Gardner, RD
• Rebecca Gardner
• Charles E. Garner, CRNA
• Deena Davon Garner, DNP, APRN
• Peggy Melissa Garner, B.A.
• Alison Denise Gasaway-Bauer, MSN, APRN, FNP-BC
• Anna Cheiron Gaspard, LCSW
• Gastro Clinics of Arkansas, PLLC
• Gastro Pathology Specialists PLLC
• Cheyenna Dawn Gates

• Plastic and Reconstructive Surgery Physician in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Plastic and Reconstructive Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.