Healthcare Provider Details

I. General information

NPI: 1497708234
Provider Name (Legal Business Name): LUTHER L GASTON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST # 1156
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST # 1156
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-0654
  • Fax:
Mailing address:
  • Phone: 305-689-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number49277
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number174591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: