WILLIAM C PETTY (NPI# 1073565008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073565008 |
| Entity Type | Individual |
| Full Name | WILLIAM C PETTY |
| Credential | M.D. |
| Practice Address |
2200 Randallia Dr Fort Wayne IN 46805-4638 |
| Mailing Address |
3707 New Vision Dr Fort Wayne IN 46845-1702 |
| Practice Telephone | 2603734000 |
| Mailing Telephone | 2604719466 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
01038794 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM | 000000092611 | 01 |
| OH | 2100621 | 05 | |
| IN | PHP | 1696 | 01 |
| MI | 4074933100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669088092 | William Petty | Speech-Language Pathologist | 28100 Torch Pkwy Ste 600, Warrenville, IL 60555-4030 | 2020-09-21 |
| 1700355237 | William Christopher Petty | Military Health Care Provider | 21227 Torch Street, Biggs Field, TX 79918 | 2018-11-14 |
| 1477994937 | William C Petty | Counselor | 351 W Swanson Ave, Suite 4, Wasilla, AK 99654-6853 | 2013-07-12 |
| 1861558744 | William D. Petty | Dentist | 4233 W 95th St, 2nd Floor, Oak Lawn, IL 60462 | 2006-12-28 |
| 1871687665 | William I Petty II | Internal Medicine | 3901 Main St Ste A, Hilton Head Island, SC 29926-4613 | 2006-10-03 |
| 1841345501 | William Mccandless Petty | Obstetrics & Gynecology | Medical Center Blvd, Winston-salem, NC 27157-0001 | 2007-01-24 |
| 1164406690 | William Jeffrey Petty Jr. | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2005-11-29 |
| Street Address |
2200 RANDALLIA DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972508471 | Matthew Paul Ziccardi | Clinical Neuropsychologist | 2200 Randallia Dr, Fort Wayne, IN 46805 | 2005-06-20 |
| 1891308896 | Cameron Buzzard | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-08-28 |
| 1558985945 | Morgan Taylor Hilbert | Pharmacist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-06-02 |
| 1952941908 | Lydia Hentz | Counselor | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-01-07 |
| 1326683228 | Nicole Marie Gaunt | Social Worker | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-11-14 |
| 1205490877 | Elisha Lynn Handshoe | Physical Medicine & Rehabilitation | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-29 |
| 1154884898 | Monique Brissette | Speech-Language Pathologist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-10 |
| 1649733411 | Clarissa Burkett | Physical Therapy Assistant | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| 1740743533 | Ross Tyler Nelson | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| 1295298982 | Jennifer Ferguson | Occupational Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376789420 | Richard Frederick Fox | Radiology | 6226 Devils Hollow Rd., Fort Wayne, IN 46814 | 2008-12-19 |
| 1578607149 | Garland Richard Brown | Radiology | 1007 Three Rivers N, Fort Wayne, IN 46802-1334 | 2007-02-16 |
| 1932205077 | Kavita K Erickson | Radiology | 5001 Us Highway 30 W, Suite D, Fort Wayne, IN 46818-9701 | 2006-09-16 |
| 1033226154 | Alan S. Cooperman | Radiology | 14110 Spring Hollow Rd, Fort Wayne, IN 46814-9767 | 2006-08-24 |
| 1336174598 | Mitchell E F Travis | Radiology | 10517 Maple Springs Cv, Fort Wayne, IN 46845-2132 | 2006-07-12 |
| 1023062130 | Gregg R Mattison | Radiology | 3707 New Vision Drive, Fort Wayne, IN 46895-5602 | 2006-05-22 |
| 1184678278 | Charles Tsai | Radiology | 109 Chestnut Hills Pkwy, Fort Wayne, IN 46814-8924 | 2006-05-22 |
| 1922061613 | Mri Center - Fort Wayne Radiology Inc | Radiology | 2110 Carew St, Fort Wayne, IN 46805-4712 | 2006-04-11 |
| 1861455669 | Open View Mri, LLC | Radiology | 10202 Coldwater Rd, Fort Wayne, IN 46825-2076 | 2006-04-11 |
| 1902870033 | Jay T Jones | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46845-1702 | 2006-02-15 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on WILLIAM C PETTY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.