Individual
DR. GARY LYNN GASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1310 E BOONE ST, TAHLEQUAH, OK 74464-3338
(918) 456-7700
Mailing address
1310 E BOONE ST, TAHLEQUAH, OK 74464-3338
(918) 456-7700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12817
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110101250A
—
OK
Enumeration date
06/29/2007
Last updated
11/16/2011
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