Provider Demographics
NPI:1952734550
Name:GAST, BROCK ANDREW (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BROCK
Middle Name:ANDREW
Last Name:GAST
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-8150
Mailing Address - Country:US
Mailing Address - Phone:641-512-5823
Mailing Address - Fax:
Practice Address - Street 1:1642 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:OAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-8150
Practice Address - Country:US
Practice Address - Phone:641-512-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD116671367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered