Provider Demographics
NPI:1265506109
Name:GASKINS, HAMPTON T (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMPTON
Middle Name:T
Last Name:GASKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1368
Mailing Address - Country:US
Mailing Address - Phone:909-937-2000
Mailing Address - Fax:909-937-2009
Practice Address - Street 1:1814 E ELMA CT
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4445
Practice Address - Country:US
Practice Address - Phone:909-937-2000
Practice Address - Fax:909-937-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G369050Medicaid
CAA46860Medicare UPIN
CA00G369050Medicare ID - Type Unspecified