Provider Demographics
NPI:1477503332
Name:GASTON, LOUIS JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOHN
Last Name:GASTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 RIEMER RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9728
Mailing Address - Country:US
Mailing Address - Phone:724-353-9782
Mailing Address - Fax:
Practice Address - Street 1:171 STALEYS COURTS RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-3709
Practice Address - Country:US
Practice Address - Phone:724-545-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001605L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant