Healthcare Provider Details

I. General information

NPI: 1063404689
Provider Name (Legal Business Name): PETAR TURCINOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 PINECROFT DR SUITE 250
SHENANDOAH TX
77380-3279
US

IV. Provider business mailing address

2559 MEDICAL DR STE 3200
ALAMOGORDO NM
88310-8703
US

V. Phone/Fax

Practice location:
  • Phone: 281-419-8400
  • Fax: 281-292-1972
Mailing address:
  • Phone: 281-419-8400
  • Fax: 281-292-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2021-0724
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL4369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: