Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2007-00236 | NC |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2007-00236 | NC |
NPI | 1053334367 |
---|---|
Provider Name | Dr. Raymond Glenn Gaston |
First Address | Charlotte, NC 28209-3239 |
Second Address | Charlotte, NC 28207-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000490473 | ANTHEM (01) | IN |
01061742A | LICENSE (01) | IN |
200852490 | (05) | IN |
5907545 | (05) | NC |