Provider Demographics
NPI:1629494828
Name:GAJIC, DESANKA (MD)
Entity Type:Individual
Prefix:DR
First Name:DESANKA
Middle Name:
Last Name:GAJIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8067 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 EAST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346
Practice Address - Country:US
Practice Address - Phone:281-812-5418
Practice Address - Fax:281-812-5458
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF22963Medicare UPIN