MEDICARE: GARY MICHAEL AGENA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME175399	FL
2	207V00000X	Obstetrics & Gynecology Physician	MD200946	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME175399	OTHER	FL	FLORIDABOARDOFMEDICINE
3	200946	OTHER		STATE LICENSE

General Provider Information

NPI Number	:	1295768406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MICHAEL AGENA M.D.

Provider Business Mailing Address
First Line	:	393 HIGHWAY 21
Second Line	:	SUITE 525
City	:	MADISONVILLE
State	:	LA
Zip	:	70447-3407
Country	:	US
Telephone Number	:	985-845-7121
Fax Number	:	985-206-9476

Provider Business Practice Location Address
First Line	:	393 HIGHWAY 21
Second Line	:	SUITE 525
City	:	MADISONVILLE
State	:	LA
Zip	:	70447-3407
Country	:	US
Telephone Number	:	985-845-7121
Fax Number	:	985-206-9476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/12/2025

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