Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | K3716 | TX |
N | 207YS0123X | Facial Plastic Surgeon | K3716 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | K3716 | TX |
NPI | 1417972225 |
---|---|
Provider Name | Yadranko Ducic |
First Address | Fort Worth, TX 76161-1205 |
Second Address | Fort Worth, TX 76104-2254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 24/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125225606 | (05) | TX |
125225607 | MEDICAID CSHCN (01) | TX |
P00265363 | RAILROAD MEDICARE (01) |