Provider Demographics
NPI:1457400327
Name:WM DARRELL GASKINS LLC
Entity Type:Organization
Organization Name:WM DARRELL GASKINS LLC
Other - Org Name:NAPLES PREMIER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANI
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-2020
Mailing Address - Street 1:2335 9TH ST N STE 304
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4457
Mailing Address - Country:US
Mailing Address - Phone:239-263-7750
Mailing Address - Fax:239-263-1754
Practice Address - Street 1:2335 9TH ST N STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4457
Practice Address - Country:US
Practice Address - Phone:239-263-7750
Practice Address - Fax:239-263-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0043376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2057Medicare ID - Type UnspecifiedMEDIARE GROUP NUMBER