Organization
JOHN E. GASTON MD DBA
Active
Other names
Fayetteville Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY EUGENE GASTON M.D. (DBA)
(910) 488-6331
Entity
Organization
Contact information
Practice address
2312B MURCHISON RD, FAYETTEVILLE, NC 28301-3518
(910) 488-6331
(910) 488-5351
Mailing address
2312B MURCHISON RD, FAYETTEVILLE, NC 28301-3518
(910) 488-6331
(910) 488-5351
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
22112
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8901585
—
NC
05
—
8934945
—
NC
Enumeration date
03/28/2007
Last updated
08/22/2020
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