Gustafson, Ray O

Gustafson, Ray O is an individual health care provider with primary practice located at 200 1St St Sw , Rochester MN 55905-0001. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Gustafson, Ray O can be contacted via phone (507) 284-2511.

Contact Information

Primary practice address
200 1St St Sw Rochester MN 55905-0001
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 24064 Minnesota

Profile Details

NPI number 1174502181
LBN Legal business name Gustafson, Ray O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2006
Last updated Nov 27th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174502181 NPPES
Minnesota MEDICAID 304220100
Minnesota MEDICAID ENROLLED
Minnesota Other 040002358
Minnesota MEDICAID ENROLLED
Minnesota MEDICAID 35192900

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