1518961499 NPI number — DR. ROBERT WILLIAM GASTON D.C.

Table of content: DR. ROBERT WILLIAM GASTON D.C. (NPI 1518961499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518961499 NPI number — DR. ROBERT WILLIAM GASTON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASTON
Provider First Name:
ROBERT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518961499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-2220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-922-5060
Provider Business Mailing Address Fax Number:
231-922-5062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-922-5060
Provider Business Practice Location Address Fax Number:
231-922-5062
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301006073 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P87962 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0B85444 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3085520 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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