Provider Demographics
NPI:1225130610
Name:DANA, GASTON (DO)
Entity Type:Individual
Prefix:
First Name:GASTON
Middle Name:
Last Name:DANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2732
Mailing Address - Country:US
Mailing Address - Phone:317-346-3883
Mailing Address - Fax:317-346-3141
Practice Address - Street 1:1155 W JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2732
Practice Address - Country:US
Practice Address - Phone:317-346-3883
Practice Address - Fax:317-346-3141
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001432B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100382270Medicaid
IN100382270Medicaid
IN220210HMedicare PIN