Provider Demographics
NPI:1700049517
Name:FRED W. GASKIN, MDPC
Entity Type:Organization
Organization Name:FRED W. GASKIN, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-205-6744
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 520 NORTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-205-6744
Mailing Address - Fax:314-576-2393
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 520 NORTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-205-6744
Practice Address - Fax:314-576-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO347482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty