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General NPI Number Information
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NPI Number | 1336105949
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Entity Type | Individual
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Provider Name | DANIEL BRUCE JOVANOVICH MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2006
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 651 COLLIERS WAY STE 511
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City | WEIRTON
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State | WV
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Zip | 26062-5054
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Country | US
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Telephone | 304-723-6801
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Fax | 740-354-2138
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Provider Business Mailing Address
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Address Line | 651 COLLIERS WAY STE 300
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City | WEIRTON
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State | WV
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Zip | 26062-5058
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Country | US
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Telephone | 304-797-6404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 3242
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD029838E
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 3242
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MD029838E
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35.092226
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License Number State | OH
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