Healthcare Provider Details

I. General information

NPI: 1073519690
Provider Name (Legal Business Name): RAYMOND A GASKINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 OWEN DR
FAYETTEVILLE NC
28304-3411
US

IV. Provider business mailing address

PO BOX 96860
CHARLOTTE NC
28296-6860
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-3183
  • Fax: 910-223-7555
Mailing address:
  • Phone: 910-323-3183
  • Fax: 910-745-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20544
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number20544
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20544
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: