Myron Jay Petruska D.O.

NPI 1043207764 - Family Medicine - 207Q00000X

NPI Details
NPI 1043207764
Gender Male
Enumeration Date 09/29/2005
Last Updated 11/13/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
209 PARK ST
SUITE 100
BELMONT NC, 28012-5205, US
Phone (704) 825-4750
Fax (704) 825-6985
Business Location
2240 REMOUNT RD
GASTONIA NC, 28054-4725, US
Phone (704) 671-5311
Fax (704) 671-5308
Toxanomy
Taxonomy Code 207Q00000X
License State North Carolina
License Number 9600678
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According to our database, Dr. Myron Jay Petruska D.O. NPI is 1043207764, taxonomy code is 207Q00000X and license number is 9600678, license state is located at North Carolina. Myron Jay Petruska D.O. physically located at 209 Park St, Belmont NC, 28012-5205. NPI Number Myron Jay Petruska D.O. has the Individual type.

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1043207764 NPI number is provided on an as is basis without warranty of any kind. 1043207764 is maintained by the National Plan & Provider Enumeration System. The contents of Myron Jay Petruska D.O. are for informational purposes only.