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General NPI Number Information
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NPI Number | 1801837281
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Entity Type | Individual
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Provider Name | KIMBERLY W GASTON DC, MD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 6067 HOLLYWOOD BLVD STE 203
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7922
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Country | US
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Telephone | 309-370-7427
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Fax |
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Provider Business Mailing Address
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Address Line | 6067 HOLLYWOOD BLVD STE 203
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7922
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Country | US
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Telephone | 309-370-7427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME168965
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME168965
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License Number State | FL
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