Provider Demographics
NPI:1205928355
Name:GASKIN, JR., DANIEL RAY (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAY
Last Name:GASKIN, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:RAY
Other - Last Name:GASKIN, JR.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:315 COMMERCIAL DR
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3628
Mailing Address - Country:US
Mailing Address - Phone:912-352-9902
Mailing Address - Fax:912-352-9960
Practice Address - Street 1:315 COMMERCIAL DR
Practice Address - Street 2:SUITE B-3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3628
Practice Address - Country:US
Practice Address - Phone:912-352-9902
Practice Address - Fax:912-352-9960
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028117207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45414Medicare UPIN