Provider Demographics
NPI:1811983877
Name:GAGIC, PREDRAG M (MD)
Entity type:Individual
Prefix:DR
First Name:PREDRAG
Middle Name:M
Last Name:GAGIC
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 1:313 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2841
Mailing Address - Country:US
Mailing Address - Phone:318-253-8655
Mailing Address - Fax:318-253-9737
Practice Address - Street 1:313 CENTER ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2841
Practice Address - Country:US
Practice Address - Phone:318-253-8655
Practice Address - Fax:318-253-9737
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2018-10-17
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
LA05101R208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D0464907OtherCLIA
LA1304841Medicaid
LA1304841Medicaid
LA51687G657Medicare PIN