Gustafson, Thomas R.

Gustafson, Thomas R. is an individual health care provider with primary practice located at 1243 Pennsylvania Ave , Pine City NY 14871-9230. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gustafson, Thomas R. can be contacted via phone (607) 734-3929.

Contact Information

Primary practice address
1243 Pennsylvania Ave Pine City NY 14871-9230
Phone: (607) 734-3929
Fax: (607) 734-0781
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD042588L Pennsylvania
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 186217-1 New York

Profile Details

NPI number 1720055528
LBN Legal business name Gustafson, Thomas R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2006
Last updated Jul 29th, 2011 - about 13 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 1720055528 NPPES
Pennsylvania MEDICAID 0012479510001
Pennsylvania MEDICAID 01255774
Pennsylvania Other 080173355
Pennsylvania Other CC8362

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