Individual
ALEXANDRE A PETRAKIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1783 TROUP HWY, TYLER, TX 75701
(903) 595-2283
(903) 595-1063
Mailing address
1783 TROUP HWY, TYLER, TX 75701-5869
(903) 595-2283
(903) 595-1063
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
K6234
TX
207RC0000X
Cardiovascular Disease Physician
K6234
TX
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
K6234
TX
207RI0011X
Interventional Cardiology Physician
K6234
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045057901
SMITH COUNTY INDIGENT
TX
05
—
045057901
—
TX
01
—
060060260
RAILROAD MEDICARE
TX
05
—
1776521
—
LA
01
—
87792Y
BCBS OF TEXAS
TX
Enumeration date
10/24/2005
Last updated
02/10/2023
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