Individual
DR. JERRY G GASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4013 N RIDGE RD, STE 210, WICHITA, KS 67205-8860
(316) 945-7309
(316) 945-9131
Mailing address
PO BOX 905, WICHITA, KS 67201-0905
(316) 945-7309
(316) 945-9131
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
05-23472
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100189280A
—
KS
Enumeration date
07/14/2005
Last updated
11/29/2011
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