Provider Demographics
NPI:1144818683
Name:GAST, JOSEPH ROGER (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROGER
Last Name:GAST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1534
Mailing Address - Country:US
Mailing Address - Phone:515-203-1539
Mailing Address - Fax:
Practice Address - Street 1:118 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1534
Practice Address - Country:US
Practice Address - Phone:515-203-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant