Provider Demographics
NPI:1629837091
Name:GASCON, GILLIAN TERESA ALONZO (DO)
Entity Type:Individual
Prefix:
First Name:GILLIAN TERESA
Middle Name:ALONZO
Last Name:GASCON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GILLIAN TERESA
Other - Middle Name:ALONZO
Other - Last Name:YAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 S GRAND BLVD RM M260
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1004
Mailing Address - Country:US
Mailing Address - Phone:314-617-2359
Mailing Address - Fax:
Practice Address - Street 1:1402 S GRAND BLVD RM M260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1004
Practice Address - Country:US
Practice Address - Phone:314-617-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program