Provider Demographics
NPI:1891817391
Name:KOVANCI, ERTUG (MD)
Entity Type:Individual
Prefix:
First Name:ERTUG
Middle Name:
Last Name:KOVANCI
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 1:111 VISION PARK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3003
Mailing Address - Country:US
Mailing Address - Phone:281-444-4784
Mailing Address - Fax:281-444-0429
Practice Address - Street 1:111 VISION PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3003
Practice Address - Country:US
Practice Address - Phone:281-444-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8777207VG0400X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165642302Medicaid
TX8L1444Medicare PIN
TX165642302Medicaid
TXTXB114345Medicare PIN
TX8J4820Medicare PIN
TX8B9957Medicare PIN