Provider Demographics
NPI:1922606367
Name:REGEN MED PLLC
Entity Type:Organization
Organization Name:REGEN MED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEZIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-864-2300
Mailing Address - Street 1:4101 GREENBRIAR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5244
Mailing Address - Country:US
Mailing Address - Phone:213-864-2300
Mailing Address - Fax:
Practice Address - Street 1:4101 GREENBRIAR DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5244
Practice Address - Country:US
Practice Address - Phone:213-864-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty