| Doctor Name: | JERRY L GASTINEAU |
| NPI Number: | 1124118971 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | MD7688 |
| Business Practice Address: | 1505 W Elk Ave Suite 2 Elizabethton, TN - 376432848 |
| Business Phone Number: | 4235431261 |
| Business Fax Number: | 4235437500 |
| Mailing Address: | 1505 W Elk Ave, Suite 2 ELIZABETHTON |
| State: | TN |
| Postal Code: | 376432848 |
| Phone Number: | 4235431261 |
| Fax Number: | 4235437500 |
| NPI Enumeration Date: | 10/13/2006 |
| NPI Last Update Date: | 12/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 170100000X |
| License Number: | MD7688 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Medical Genetics, Ph.D. Medical Genetics |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists. |