Organization
GARY M. AGENA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY MICHAEL AGENA MD (MD/OWNER)
(985) 845-7121
Entity
Organization
Contact information
Practice address
393 HIGHWAY 21, SUITE 525, MADISONVILLE, LA 70447-3407
(985) 845-7121
(985) 206-9476
Mailing address
393 HIGHWAY 21, SUITE 525, MADISONVILLE, LA 70447-3407
(985) 845-7121
(985) 206-9476
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MD200946
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1504050
—
LA
Enumeration date
07/30/2012
Last updated
07/30/2012
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