Basic Information
| Provider Information | |||||||||
| NPI: | 1790822443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GASKIN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1326 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756711326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039273782 | ||||||||
| FaxNumber: | 9039271764 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 S WASHINGTON AVE | ||||||||
| Address2: | SUITE # 203 | ||||||||
| City: | MARSHALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039276850 | ||||||||
| FaxNumber: | 9039276857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 05/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | J0495 | TX | N | Other Service Providers | Specialist | 207V00000X | J0495 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 091788201 | 05 | TX | MEDICAID | H76Q | 01 | TX | BLUE CROSS BLUE SHIELD PR | OTHER |