Provider Demographics
NPI:1164496105
Name:GASTON, CALEB O (MD)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:O
Last Name:GASTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5206 VILLAGE PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8137
Mailing Address - Country:US
Mailing Address - Phone:479-657-6600
Mailing Address - Fax:479-657-6632
Practice Address - Street 1:5206 VILLAGE PKWY STE 10
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8137
Practice Address - Country:US
Practice Address - Phone:479-657-6600
Practice Address - Fax:479-657-6632
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-3376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148082001Medicaid
ARH68466Medicare UPIN