Basic Information
| Provider Information | |||||||||
| NPI: | 1740713668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GASQUE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | NATHANIEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GASQUE | ||||||||
| OtherFirstName: | NATHAN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 S LEWIS PLZ | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296052944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642424122 | ||||||||
| FaxNumber: | 8645123702 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 S LEWIS PLZ | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296052944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642424122 | ||||||||
| FaxNumber: | 8645123702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 08/08/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 51148 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | LL51148 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.