Provider Demographics
NPI:1316217995
Name:LAWRENCE R GASTON DPM PA
Entity Type:Organization
Organization Name:LAWRENCE R GASTON DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:785-843-0973
Mailing Address - Street 1:5100 BOB BILLINGS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3998
Mailing Address - Country:US
Mailing Address - Phone:785-843-0973
Mailing Address - Fax:785-843-1839
Practice Address - Street 1:5100 BOB BILLINGS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3998
Practice Address - Country:US
Practice Address - Phone:785-843-0973
Practice Address - Fax:785-843-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00197261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric