Provider Demographics
NPI:1609513290
Name:GASQUE, MARIA (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GASQUE
Suffix:
Gender:F
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:TEXAS TECH UNIVERSITY HSC DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:3601 4TH STREET STOP 9406
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430
Mailing Address - Country:US
Mailing Address - Phone:806-743-7660
Mailing Address - Fax:
Practice Address - Street 1:TEXAS TECH UNIVERSITY HSC DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:3601 4TH STREET STOP 9406
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXBP10080287390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program