Anton Cyril Petrash, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

E0036 Issued in AR

Practice address

1100 N College Ave
116A/MHC
Fayetteville, AR 72703

Phone

(479) 444-5038

Fax

(479) 444-5039

NPI assigned

Jul 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1881627271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 BRICKWAY BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038226",
            "telephone_number": "707-569-2367",
            "fax_number": "707-569-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N COLLEGE AVE",
            "address_2": "116A/MHC",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-444-5038",
            "fax_number": "479-444-5039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 N College Ave",
            "address_2": "116A/MHC",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727031944",
            "country_code": "US",
            "telephone_number": "479-444-5038 x5701",
            "fax_number": "479-444-5039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRASH",
        "first_name": "ANTON",
        "middle_name": "CYRIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C156947",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "E0036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125759001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROV #",
            "identifier": "5J418",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brent P Peterson, DO
• Emily Peterson, O.D
• Micah Peterson
• Rachel Ann Peterson, M.S., L.A.C
• Skye C Peterson, BS, QBHP
• Patricia Ann Petretic, PH.D.
• Claire Petrie, MS, CCC-SLP
• David P Petros, M.D.
• Keeli Holden Pfeiffer, LCSW
• Hanh Kieu Pham, RPH

• Psychiatry Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Psychiatry Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.