Provider Demographics
NPI:1245994227
Name:GASTON, CAMERON BARTHOLOMEW JR
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:BARTHOLOMEW
Last Name:GASTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 PRESSBURG ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126
Mailing Address - Country:US
Mailing Address - Phone:504-452-1450
Mailing Address - Fax:
Practice Address - Street 1:3901 ULLOA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-267-5712
Practice Address - Fax:504-267-5714
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator