Provider Demographics
NPI:1548911423
Name:PETTY, STEVEN II
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:PETTY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 S 705 RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:OK
Mailing Address - Zip Code:74370-9507
Mailing Address - Country:US
Mailing Address - Phone:918-303-5433
Mailing Address - Fax:918-615-9666
Practice Address - Street 1:10025 S 705 RD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:OK
Practice Address - Zip Code:74370-9507
Practice Address - Country:US
Practice Address - Phone:918-303-5433
Practice Address - Fax:918-615-9666
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist