Provider Demographics
NPI:1336105949
Name:JOVANOVICH, DANIEL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRUCE
Last Name:JOVANOVICH
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 1:651 COLLIERS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5058
Mailing Address - Country:US
Mailing Address - Phone:304-797-6404
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY STE 511
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5054
Practice Address - Country:US
Practice Address - Phone:304-723-6801
Practice Address - Fax:740-354-2138
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3242207RC0000X, 207RI0011X
PAMD029838E207RC0000X, 207RI0011X
OH35.092226207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2886597Medicaid
KY7100058740OtherKENTUCKY MEDICAID
OH2886597Medicaid
TN4063042OtherBLUE CROSS
KY7100058740Medicaid
TN3883725Medicare ID - Type Unspecified
KY7100058740OtherKENTUCKY MEDICAID