1518953934 NPI number — DAVID M GAST MD

Table of content: DAVID M GAST MD (NPI 1518953934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518953934 NPI number — DAVID M GAST MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAST
Provider First Name:
DAVID
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1518953934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SANDPOINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNISING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49862-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-387-4338
Provider Business Mailing Address Fax Number:
906-387-2825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 GRACELAWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04210-6334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-333-4799
Provider Business Practice Location Address Fax Number:
207-333-4767
Provider Enumeration Date:
09/21/2005

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: 208100000X , with the licence number:  4301051117 , 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: 0690010 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1518953934 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2855852 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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