MEDICARE: RONALD J GASKIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	R4346	MO

General Provider Information

NPI Number	:	1982690004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD J GASKIN MD

Provider Business Mailing Address
First Line	:	PO BOX 1209
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-0209
Country	:	US
Telephone Number	:	314-576-7213
Fax Number	:	314-576-4755

Provider Business Practice Location Address
First Line	:	3535 S JEFFERSON AVE
Second Line	:	#201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3930
Country	:	US
Telephone Number	:	314-577-5778
Fax Number	:	314-577-5726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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