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General NPI Number Information
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NPI Number | 1316656481
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Entity Type | Organization
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Legal Business Name | GASTON FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 2290 REMOUNT RD
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City | GASTONIA
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State | NC
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Zip | 28054-4725
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Country | US
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Telephone | 704-867-1402
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Fax | 888-720-2814
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Provider Business Mailing Address
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Address Line | 2290 REMOUNT RD
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City | GASTONIA
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State | NC
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Zip | 28054-4725
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Country | US
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Telephone | 704-867-1402
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Fax | 704-671-2028
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | DEREK REED
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Credential | DO
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Telephone | 704-867-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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