Provider Demographics
NPI:1093772402
Name:SAGRERA, GEORGE DOUGLAS SR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:SAGRERA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3633
Mailing Address - Country:US
Mailing Address - Phone:337-364-8196
Mailing Address - Fax:337-367-5258
Practice Address - Street 1:602 W SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3633
Practice Address - Country:US
Practice Address - Phone:337-364-8196
Practice Address - Fax:337-367-5258
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008438208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1062138Medicaid
LA1062138Medicaid
LA55785Medicare ID - Type Unspecified