Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | L8888 | TX |
NPI | 1013948397 |
---|---|
Provider Name | Pauline Petrovski |
First Address | Frisco, TX 75035-0521 |
Second Address | Frisco, TX 75035-0524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 05/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1729220 | (05) | TX |
7590585 | AETNA INDIVIDUAL (01) | TX |
8R2082 | BCBS INDIVIDUAL (01) | TX |
I22592 | (02) | TX |