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Individual

JERRY L GASTINEAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
(423) 543-1261
(423) 543-7500
Mailing address
1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
(423) 543-1261
(423) 543-7500

Taxonomy

Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
MD7688
TN
207Q00000X
Family Medicine Physician
Primary
7688
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
201575
BLUECARE
TN
05
3152032
TN
01
4360576
BCBS
TN
01
BLUECROSS
201575
TN
01
TN0102
AMERICHOICE
TN
Enumeration date
10/13/2006
Last updated
12/18/2014
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