Provider Demographics
NPI:1306195722
Name:NIKOLA GAJIC MD PA
Entity Type:Organization
Organization Name:NIKOLA GAJIC MD PA
Other - Org Name:ATASCOCITA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-812-5418
Mailing Address - Street 1:8067 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1764
Mailing Address - Country:US
Mailing Address - Phone:281-812-5418
Mailing Address - Fax:281-812-5458
Practice Address - Street 1:8067 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-1764
Practice Address - Country:US
Practice Address - Phone:281-812-5418
Practice Address - Fax:281-812-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0036261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care