Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | 0101038298 | VA |
Y | 2080P0214X | Pediatric Pulmonologist | 01082297A | IN |
NPI | 1427177666 |
---|---|
Provider Name | Benjamin M. Gaston |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006713912 | (05) | VA |
0074463 | (05) | OH |
G03234 | (02) | VA |