MR. GARY MICHAEL PETRUS (NPI# 1568525806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568525806 |
| Entity Type | Individual |
| Full Name | MR. GARY MICHAEL PETRUS |
| Credential | MD |
| Practice Address |
4137 John F Kennedy Blvd Ste A N Little Rock AR 72116-8230 |
| Mailing Address |
Po Box 241580 Little Rock AR 72223-0011 |
| Practice Telephone | 5016143052 |
| Practice Fax Number | 5016143057 |
| Mailing Telephone | 5016143052 |
| Mailing Fax Number | 5016143057 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2019-01-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
C7318 | AR | Allopathic & Osteopathic Physicians |
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
C7318 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 114482001 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2504 Mccain Blvd, Ste 114, North Little Rock, AR 72116 | 5017589800 | 5017580199 |
| Street Address |
4137 JOHN F KENNEDY BLVD STE A |
| City | N LITTLE ROCK |
| State | AR |
| Zip Code | 72116-8230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710509997 | Dickerson Family Resource Center, LLC | Counselor | 5401 John F. Kennedy Blvd, Suite I Rm 1, North Little Rock, AR 72116 | 2020-05-11 |
| 1831609262 | Bill J Carpenter Sr. | Counselor | 4700 W Commercial Dr Ste B3, North Little Rock, AR 72116 | 2017-10-12 |
| 1992257646 | Meagan Booe | Behavioral Analyst | 3812 Lakewood Valley Drive, North Little Rock, AR 72116 | 2016-10-28 |
| 1295154300 | Min-ji Lee | Family Medicine | 2504 Mccain Blvd Ste 118, North Little Rock, AR 72116 | 2014-04-16 |
| 1255603486 | Crystal N Lackey | Physical Therapist | 3801 Jfk Blvd Ste C, North Little Rock, AR 72116 | 2012-02-03 |
| 1003055724 | North Little Rock, Pllc | Chiropractor | 4614 Jfk Blvd, North Little Rock, AR 72116 | 2009-02-19 |
| 1891933826 | Jennifer Ann Freilino | Counselor | 3805 Mccain Park Dr Ste 112, North Little Rock, AR 72116 | 2009-01-29 |
| 1679729669 | Amy Marie Jones | Speech-Language Pathologist | 5901 John F Kennedy Blvd Apt 5127, North Little Rock, AR 72116 | 2008-08-11 |
| 1992970917 | Ronald F Boyles Od Pa | Eyewear Supplier (Equipment, not the service) | 2520 Crestwood Road, North Little Rock, AR 72116 | 2008-04-30 |
| 1992976377 | Kencur Inc Statco Hearing Labs | Hearing Instrument Specialist | 4000 Mccain Blvd, Suite D, North Little Rock, AR 72116 | 2008-03-13 |
| Find all providers in zip 72116 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780282566 | Lauren Tilley | Surgery | 4301 W Markham St # 720, Little Rock, AR 72205-7101 | 2020-10-13 |
| 1689021420 | Boyette Facial Plastic Surgery, Pa | Surgery | 9601 Lile Dr., Medical Towers Building 1, Suite 970b, Little Rock, AR 72205-6321 | 2016-05-23 |
| 1588899645 | Eric Jason Wright | Surgery | 1701 Centerview Dr Ste 201, Little Rock, AR 72211-4312 | 2009-05-19 |
| 1871666446 | Gary M Petrus Md Pa | Surgery | 2504 Mccain Blvd, Suite 114, North Little Rock, AR 72116-7624 | 2006-11-15 |
| 1841381662 | Roger N. Bise, Md Pa | Surgery | 2713 S 74th St, Suite 302, Fort Smith, AR 72903-5170 | 2006-09-27 |
| 1225042377 | Adam G. Newman | Surgery | 200 N College St, Mountain Home, AR 72653-3654 | 2006-07-27 |
| 1649236852 | Roger Neal Bise | Surgery | 2713 S 74th St, Suite 302, Fort Smith, AR 72903-5170 | 2006-04-25 |
| 1114989233 | Suzanne Wong Yee | Surgery | 11811 Hinson Rd, Little Rock, AR 72212 | 2006-04-04 |
| City | N LITTLE ROCK |
| Zip Code | 72116 |
Please comment or provide details below to improve the information on MR. GARY MICHAEL PETRUS.
| 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.