=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134380413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETAR TURCINOVIC MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2008
-----------------------------------------------------
Last Update Date | 06/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 PINECROFT DR SUITE 250
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-419-8400
-----------------------------------------------------
Fax | 281-292-1972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9200 PINECROFT DR SUITE 250
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-419-8400
-----------------------------------------------------
Fax | 281-292-1972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PETAR TURCINOVIC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-419-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | L4369
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------