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General NPI Number Information
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NPI Number | 1588765440
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Entity Type | Organization
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Legal Business Name | LAWRENCE R. GASTON, JR DPM PA
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 5100 BOB BILLINGS PARKWAY SUITE 100
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City | LAWRENCE
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State | KS
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Zip | 66049-4094
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Country | US
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Telephone | 785-843-0973
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Fax | 785-843-1839
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Provider Business Mailing Address
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Address Line | 5100 BOB BILLINGS PARKWAY SUITE 100
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City | LAWRENCE
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State | KS
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Zip | 66049-4094
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Country | US
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Telephone | 785-843-0973
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Fax | 785-843-1839
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE RANDOLPH GASTON JR.
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Credential | DPM
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Telephone | 785-843-0973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1200197
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1200197
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License Number State | KS
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