Healthcare Provider Details

I. General information

NPI: 1538428602
Provider Name (Legal Business Name): JEFFERY PETROSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WESTVIEW BLVD
CONROE TX
77304-3596
US

IV. Provider business mailing address

3 LAGUNA RD
MONTGOMERY TX
77356-5337
US

V. Phone/Fax

Practice location:
  • Phone: 936-441-2412
  • Fax:
Mailing address:
  • Phone: 713-598-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80208
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: