Provider Demographics
NPI:1982683199
Name:PEJIC, RADE N (MD)
Entity Type:Individual
Prefix:DR
First Name:RADE
Middle Name:N
Last Name:PEJIC
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 1:4200 HOUMA BLVD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-503-6781
Mailing Address - Fax:504-503-5667
Practice Address - Street 1:4228 HOUMA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3004
Practice Address - Country:US
Practice Address - Phone:504-454-7878
Practice Address - Fax:504-883-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80689207Q00000X
LA15695R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15695ROtherSTATE MEDICAL LICENSE
LA1464431Medicaid
CAA80689OtherSTATE LICENSE
LA4G0036677Medicare ID - Type Unspecified
LA1464431Medicaid