Provider Demographics
NPI:1891717187
Name:GASTON, CAROLYN JO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:JO
Last Name:GASTON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 MATISSE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1750
Mailing Address - Country:US
Mailing Address - Phone:972-980-1943
Mailing Address - Fax:972-980-1943
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1976
Practice Address - Fax:214-857-2024
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6653146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF6653OtherSTATE MEDICAL LISCENCE
TXC16020Medicare ID - Type Unspecified