Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20544 | NC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 20544 | NC |
NPI | 1073519690 |
---|---|
Provider Name | Dr. Raymond A Gaskins JR. |
First Address | Fayetteville, NC 28304-3411 |
Second Address | Fayetteville, NC 28304-3411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8934910 | (05) | NC |
C83988 | (02) | NC |