Healthcare Provider Details

I. General information

NPI: 1184623407
Provider Name (Legal Business Name): ANDREI C GASIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/04/2012
Certification Date: GASIC ANDREI C PO BOX 847176 DALLAS TX 75284 707 HOLLYBROOK DR LONGVIEW TX 75605
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 HOLLYBROOK DR SUITE 503
LONGVIEW TX
75605-2410
US

IV. Provider business mailing address

PO BOX 847176
DALLAS TX
75284-7176
US

V. Phone/Fax

Practice location:
  • Phone: 903-753-3331
  • Fax: 903-753-3491
Mailing address:
  • Phone: 903-237-1800
  • Fax: 903-237-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH2396
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology
License NumberH2396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: