Basic Information
| Provider Information | |||||||||
| NPI: | 1982683199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEJIC | ||||||||
| FirstName: | RADE | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 HOUMA BLVD | ||||||||
| Address2: | MEDICAL STAFF SERVICES | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045036781 | ||||||||
| FaxNumber: | 5045035667 | ||||||||
| Practice Location | |||||||||
| Address1: | 4228 HOUMA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700063004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044547878 | ||||||||
| FaxNumber: | 5048833775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A80689 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 15695R | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 15695R | 01 | LA | STATE MEDICAL LICENSE | OTHER | 1464431 | 05 | LA | MEDICAID | A80689 | 01 | CA | STATE LICENSE | OTHER |