MEDICARE: YADRANKO DUCIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	K3716	TX
2	207YS0123X	Facial Plastic Surgery Physician	K3716	TX
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	K3716	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00265363	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417972225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADRANKO DUCIC MD

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-920-0068

Provider Business Practice Location Address
First Line	:	923 PENNSYLVANIA AVENUE
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2254
Country	:	US
Telephone Number	:	817-920-0484
Fax Number	:	817-920-0068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/24/2013

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Directions to “ YADRANKO DUCIC MD” Practice Location

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