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General NPI Number Information
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NPI Number | 1811036981
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Entity Type | Individual
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Provider Name | EUGEN BOGDAN PETCU MD
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | GRIFFITH UNIV SCHOOL OF MEDICINE, DEPT OF PATHOLOGY 16-30 HIGH STREET
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City | SOUTHPORT
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State | QUEENSLAND
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Zip | 4215
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Country | AU
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Telephone | 01161756780761
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Fax |
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Provider Business Mailing Address
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Address Line | GRIFFITH UNIV SCHOOL OF MEDICINE, DEPT OF PATHOLOGY 16-30 HIGH STREET
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City | SOUTHPORT
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State | QUEENSLAND
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Zip | 4215
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Country | AU
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Telephone | 01161756780761
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 216274
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License Number State | MA
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