Individual
YADRANKO DUCIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
923 PENNSYLVANIA AVENUE, SUITE 100, FORT WORTH, TX 76104-2254
(817) 920-0484
(817) 920-0068
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 920-0068
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
K3716
TX
207YS0123X
Facial Plastic Surgery Physician
K3716
TX
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
K3716
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125225606
—
TX
01
—
125225607
MEDICAID CSHCN
TX
01
—
P00265363
RAILROAD MEDICARE
—
Enumeration date
07/13/2006
Last updated
09/24/2013
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