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General NPI Number Information
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NPI Number | 1831015577
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Entity Type | Organization
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Legal Business Name | REPUBLIC LONGEVITY LLC
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 3201 UNIVERSITY DR E STE 370
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City | BRYAN
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State | TX
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Zip | 77802-3485
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Country | US
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Telephone | 979-703-1426
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Fax |
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Provider Business Mailing Address
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Address Line | 10592 COUNTY ROAD 175
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City | IOLA
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State | TX
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Zip | 77861-3617
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Country | US
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Telephone | 979-703-1426
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. DENA GASKIN
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Credential |
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Telephone | 979-229-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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