MEDICARE: ROMAN V PETROV 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	208600000X	Surgery Physician	T8915	TX
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD440971	PA
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	T8915	TX

General Provider Information

NPI Number	:	1437266822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN V PETROV MD

Provider Business Mailing Address
First Line	:	PO BOX 650859, DEPT. 710
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0859
Country	:	US
Telephone Number	:	409-772-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5143
Country	:	US
Telephone Number	:	832-505-4000
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	11/11/2022

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Directions to “ ROMAN V PETROV MD” Practice Location

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