Individual
DR. FARRAH NICOLE GASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(334) 412-6504
Mailing address
914 COUNTY ROAD 43, CAMDEN, AL 36726-3920
(334) 412-6504
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125077841
IL
208000000X
Pediatrics Physician
125077841
IL
390200000X
Student in an Organized Health Care Education/Training Program
390200000X
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
03/27/2021
Last updated
06/11/2024
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