Healthcare Provider Details

I. General information

NPI: 1497709125
Provider Name (Legal Business Name): MIROSLAV GRGUREVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVE
TURLOCK CA
95382
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-4200
  • Fax: 209-669-2377
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA40300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: