Provider Demographics
NPI:1518953934
Name:GAST, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:GAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 SANDPOINT RD
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1406
Mailing Address - Country:US
Mailing Address - Phone:906-387-4338
Mailing Address - Fax:906-387-2825
Practice Address - Street 1:15 GRACELAWN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6334
Practice Address - Country:US
Practice Address - Phone:207-333-4799
Practice Address - Fax:207-333-4767
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2021-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051117208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0690010OtherBLUE SHIELD
ME1518953934Medicaid
MI2855852Medicaid
MI2855852Medicaid