Healthcare Provider Details

I. General information

NPI: 1801837281
Provider Name (Legal Business Name): KIMBERLY W GASTON DC, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 HOLLYWOOD BLVD STE 203
HOLLYWOOD FL
33024-7922
US

IV. Provider business mailing address

6067 HOLLYWOOD BLVD STE 203
HOLLYWOOD FL
33024-7922
US

V. Phone/Fax

Practice location:
  • Phone: 309-370-7427
  • Fax:
Mailing address:
  • Phone: 309-370-7427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME168965
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME168965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: