Healthcare Provider Details

I. General information

NPI: 1033347075
Provider Name (Legal Business Name): RICHARD LARRY GASTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HOUSTON RD
FLORENCE KY
41042-4824
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-8074
  • Fax: 859-212-4357
Mailing address:
  • Phone: 859-301-8074
  • Fax: 859-301-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number48502
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48502
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: