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General NPI Number Information
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NPI Number | 1417182619
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Entity Type | Organization
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Legal Business Name | GASTON I. S. DIALLO, MD, PA
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 113 DELAWARE ST SUITE E
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2822
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Country | US
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Telephone | 913-682-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 113 DELAWARE ST SUITE E
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2822
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Country | US
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Telephone | 913-682-9030
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Fax |
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Authorized Official
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Title or Position | GASTROENTEROLOGIST
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Name | DR. GASTON I. S. DIALLO
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Credential | M.D.
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Telephone | 913-682-9030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 04-16539
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License Number State | KS
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