Provider Demographics
NPI:1063404689
Name:TURCINOVIC, PETAR (MD)
Entity type:Individual
Prefix:
First Name:PETAR
Middle Name:
Last Name:TURCINOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:STE 3200
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:281-419-8400
Mailing Address - Fax:281-292-1972
Practice Address - Street 1:9200 PINECROFT DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3279
Practice Address - Country:US
Practice Address - Phone:281-419-8400
Practice Address - Fax:281-292-1972
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0724208600000X
TXL4369208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000947D3Medicaid
TXP000947D3Medicaid
TX00947DMedicare ID - Type Unspecified