Provider Demographics
NPI:1063423119
Name:GLIGORIC, GORDANA (MD)
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:GLIGORIC
Suffix:
Gender:F
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:PO BOX 1182
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1182
Mailing Address - Country:US
Mailing Address - Phone:210-807-3889
Mailing Address - Fax:210-888-5851
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:SUITE 6100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-807-3889
Practice Address - Fax:210-888-5851
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3660207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000020861TOtherHUMANA
TX7219671OtherAETNA
TX166489801Medicaid
TX4310797OtherBLULINK
TX8H4105OtherBCBS
TX7219671OtherAETNA
TXI10797Medicare UPIN