WILLIAM ROBERT PETTEY (NPI# 1487642450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487642450 |
| Entity Type | Individual |
| Full Name | WILLIAM ROBERT PETTEY |
| Credential | MD |
| Practice Address |
6100 Harris Pkwy #390 Fort Worth TX 76132-4124 |
| Practice Telephone | 8173709011 |
| Practice Fax Number | 8173460380 |
| Mailing Telephone | 8173709011 |
| Mailing Fax Number | 8173460380 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2019-08-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | G8340 | TX | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | G8340 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA | 4254295 | 01 | |
| AETNA | 91159 | 01 | |
| TX | 131434601 | 05 |
| Street Address |
6100 HARRIS PKWY #390 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76132-4124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851392401 | Fredric Dorhauer Johnson | Family Medicine | 6100 Harris Pkwy, Suite 205, Fort Worth, TX 76132-4124 | 2005-08-04 |
| 1417583030 | Isabelle Nyota | Registered Nurse | 6100 Harris Pkwy, Fort Worth, TX 76132-4101 | 2020-03-15 |
| 1134632029 | Erin Lynn Morehead | Nurse Practitioner | 6100 Harris Pkwy, Fort Worth, TX 76132-4101 | 2017-11-14 |
| 1013431642 | Pamela J Mainous | Specialist/Technologist, Other | 6100 Harris Pkwy, Fort Worth, TX 76132-4101 | 2017-07-25 |
| 1265881767 | Lisa Phillips | Physician Assistant | 6100 Harris Pkwy, Fort Worth, TX 76132-4101 | 2016-06-07 |
| 1174980536 | Elizabeth Baker | Physician Assistant | 6100 Harris Pkwy, Fort Worth, TX 76132-4101 | 2016-01-15 |
| 1033506480 | Jose Calderon | Physician Assistant | 6100 Harris Pkwy, Suite 345, Fort Worth, TX 76132-4101 | 2015-04-23 |
| 1447646559 | Azfar Syed | Family Medicine | 6100 Harris Pkwy, Fort Worth, TX 76132-4101 | 2015-04-15 |
| 1174919641 | Grant Warren Potter | Family Medicine | 6100 Harris Pkwy, Fort Worth, TX 76132 | 2015-04-12 |
| 1306241583 | Jennifer Lynn Chavez | Nurse Practitioner | 6100 Harris Pkwy, Suite # 285, Fort Worth, TX 76132-4101 | 2014-10-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528669843 | Rubilene Spinks | Pharmacist | 6300 Oakmount Blvd, Fort Worth, TX 76132 | 2020-11-03 |
| 1942839113 | Fort Physicians & Professionals Pllc | Psychiatry & Neurology | 7140 Oakmont Boulevard, Fort Worth, TX 76132 | 2020-04-08 |
| 1134781792 | Daniel Max & Marcandrea LLC | Optometrist | 4619 S Hulen St, Suite C, Fort Worth, TX 76132 | 2019-07-03 |
| 1568029320 | Ty Desilets | Physical Therapist | 5959 Bryant Irvin Rd Suite 100, Fort Worth, TX 76132 | 2019-05-28 |
| 1750844049 | Fort Worth Surgical Center Lp | Clinic/Center | 6949 Bryant Irvin Road, Fort Worth, TX 76132 | 2019-04-12 |
| 1063971232 | Symetria Health of Texas, LLC | Clinic/Center | 7299 Hawkins View Drive, Fort Worth, TX 76132 | 2019-03-18 |
| 1275015612 | Falguni Udayan Patel | Nurse Practitioner | 6100 Harris Pkwy Ste 1230, Fort Worth, TX 76132 | 2018-09-02 |
| 1881110161 | Because De Cares | Private Vehicle | 7101 Bryant Irving Road #33104, Fort Worth, TX 76132 | 2017-08-17 |
| 1871045708 | Cns - F.w., LLC | Clinic/Center | 6940 Harris Parkway, Fort Worth, TX 76132 | 2016-10-26 |
| 1790233294 | Prime Diagnostic Imaging of Fort Worth, LLC | Clinic/Center | 6491 Southwest Blvd., Benbrook, TX 76132 | 2016-09-14 |
| Find all providers in zip 76132 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770184020 | Kara Fenceroy | Family Medicine | 5425 Rolling Meadows Dr, Fort Worth, TX 76123-2836 | 2020-11-03 |
| 1003416207 | Adeline Galvez | Family Medicine | 1300 W Terrell Ave Ste 270, Fort Worth, TX 76104-2820 | 2020-10-27 |
| 1952870354 | Nancy Carolina Nicoloso | Family Medicine | 6302 Lake Worth Blvd Ste A3963, Fort Worth, TX 76135-3607 | 2018-11-15 |
| 1245717586 | Julia Dubose | Family Medicine | 4100 Heritage Trace Pkwy Ste 116, Fort Worth, TX 76244 | 2018-07-19 |
| 1609307115 | Yara Hamade Gonzales | Family Medicine | 4701 Bryant Irvin Rd, Fort Worth, TX 76132-3603 | 2017-03-26 |
| 1558732321 | Andres Morgado Perez | Family Medicine | 1325 Pennsylvania Ave Ste 750, Fort Worth, TX 76104-2168 | 2015-10-19 |
| 1114304805 | Davis Wellness Ltd LLP | Family Medicine | 3750 S. University Dr., Suite 201, Fort Worth, TX 76109-3701 | 2015-05-01 |
| 1902298417 | Jack Lynwood Judson, Md | Family Medicine | 1800 Malibar Rd, Fort Worth, TX 76116-1834 | 2015-02-21 |
| 1104243468 | Henry Dollahite | Family Medicine | 6205 Locke Ave, Fort Worth, TX 76116-4636 | 2014-03-25 |
| 1447676689 | Janet Shackelford | Family Medicine | 5001 Golden Triangle Blvd, # 1024, Fort Worth, TX 76244 | 2014-03-12 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76132 |
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| 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.