Provider Demographics
NPI:1740713668
Name:GASQUE, WILLIAM NATHANIEL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NATHANIEL
Last Name:GASQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:
Other - Last Name:GASQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3793 MCDOWELL LANE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566
Mailing Address - Country:US
Mailing Address - Phone:843-390-0100
Mailing Address - Fax:843-390-0038
Practice Address - Street 1:3793 MCDOWELL LANE SUITE 100
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566
Practice Address - Country:US
Practice Address - Phone:843-390-0100
Practice Address - Fax:843-390-0038
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51148207QS0010X
SCLL51148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine