Gustafson, Caitlin J.
Gustafson, Caitlin J. is an individual health care provider with primary practice located at 211 Forest St , Mccall ID 83638. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Gustafson, Caitlin J. can be contacted via phone (208) 634-2225.Contact Information
Primary practice address
211 Forest St
Mccall ID 83638
Phone: (208) 634-2225
Fax: (208) 634-5547
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M9146 | Idaho |
Profile Details
| NPI number | 1295764405 |
|---|---|
| LBN Legal business name | Gustafson, Caitlin J. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2006 |
| Last updated | Aug 2nd, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295764405 | NPPES |
| Idaho | Other | B6157 | BC CMMC |
| Idaho | Other | 000010157054 | BC CMMC |
| Idaho | Other | 76664 | BC CMMC |
| Idaho | MEDICAID | 806631600 | BC CMMC |
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