Provider Demographics
NPI:1619976842
Name:GASTON, LAWRENCE R JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:R
Last Name:GASTON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4000 W 6TH STREET SUITE B # 224
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-766-2322
Mailing Address - Fax:
Practice Address - Street 1:2250 LAKE POINTE DR UNIT 802
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-9201
Practice Address - Country:US
Practice Address - Phone:785-766-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200197213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS480002560OtherRAILROAD MEDICARE
KS0210710001OtherCIGNA MEDICARE
KS006728OtherBCBS KS
KS20766017OtherBCBS KC
KS0210710001Medicare NSC
KS0210710001OtherCIGNA MEDICARE
KSKA2455Medicare PIN