Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | L3660 | TX |
N | 207RA0201X | Internist - Allergy & Immunology | L3660 | TX |
NPI | 1063423119 |
---|---|
Provider Name | Gordana Gligoric |
First Address | Helotes, TX 78023-1182 |
Second Address | San Antonio, TX 78229-5640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 21/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000020861T | HUMANA (01) | TX |
166489801 | (05) | TX |
4310797 | BLULINK (01) | TX |
7219671 | AETNA (01) | TX |
8H4105 | BCBS (01) | TX |
I10797 | (02) | TX |