Healthcare Provider Details

I. General information

NPI: 1922062785
Provider Name (Legal Business Name): BRIAN W GASKILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ASH STREET
SPOONER WI
54801
US

IV. Provider business mailing address

707 ASH STREET
SPOONER WI
54801
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-2151
  • Fax:
Mailing address:
  • Phone: 715-635-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49467
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: