Provider Demographics
NPI:1558403337
Name:GASIC, SLAVISA (MD)
Entity Type:Individual
Prefix:
First Name:SLAVISA
Middle Name:
Last Name:GASIC
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:7355 BARLITE BLVD STE 504
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1341
Practice Address - Country:US
Practice Address - Phone:210-616-9922
Practice Address - Fax:210-616-9901
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4790207RH0003X
IA39358207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01654273OtherRAILROAD
TX186286404Medicaid
TX389106YKYCMedicare PIN