Provider Demographics
NPI:1588765440
Name:LAWRENCE R. GASTON, JR DPM PA
Entity type:Organization
Organization Name:LAWRENCE R. GASTON, JR DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:785-843-0973
Mailing Address - Street 1:5100 BOB BILLINGS PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4094
Mailing Address - Country:US
Mailing Address - Phone:785-843-0973
Mailing Address - Fax:785-843-1839
Practice Address - Street 1:5100 BOB BILLINGS PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4094
Practice Address - Country:US
Practice Address - Phone:785-843-0973
Practice Address - Fax:785-843-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200197213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST43843Medicare UPIN
KS006728Medicare ID - Type UnspecifiedKS MEDICARE
0210710001Medicare NSC