Provider Demographics
NPI:1386792588
Name:WM DARRELL GASKINS LLC
Entity type:Organization
Organization Name:WM DARRELL GASKINS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANI
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-2020
Mailing Address - Street 1:2335 9TH ST N STE 304
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4457
Mailing Address - Country:US
Mailing Address - Phone:239-263-7750
Mailing Address - Fax:239-263-1754
Practice Address - Street 1:2335 9TH ST N STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4457
Practice Address - Country:US
Practice Address - Phone:239-263-7750
Practice Address - Fax:239-263-1754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WM DARRELL GASKINS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL997261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69GOtherBLUE CROSS BLUE SHIELD FL
FL3250454OtherAETNA
FL7681241001OtherCIGNA
FL079218700Medicaid
FL490000959OtherRAILROAD RETIRE. MEDICARE
FL7681241001OtherCIGNA
FL69GOtherBLUE CROSS BLUE SHIELD FL