Gustafson, Mark D.
Gustafson, Mark D. is an individual health care provider with primary practice located at 115 10Th Ave Ne , Deer River MN 56636-8795. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gustafson, Mark D. can be contacted via phone (218) 246-8275.Contact Information
Primary practice address
115 10Th Ave Ne
Deer River MN 56636-8795
Phone: (218) 246-8275
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 34203 | Minnesota |
Profile Details
| NPI number | 1467439000 |
|---|---|
| LBN Legal business name | Gustafson, Mark D. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 26th, 2005 |
| Last updated | Dec 21st, 2017 - about 7 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 | 1467439000 | NPPES |
| Minnesota | MEDICAID | 430703800 |
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