Gustavson, Edward Ernest

Gustavson, Edward Ernest is an individual health care provider with primary practice located at 1310 E Boone St , Tahlequah OK 74464-3338. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics is his primary health care specialty. Gustavson, Edward Ernest can be contacted via phone (918) 456-7700.

Contact Information

Primary practice address
1310 E Boone St Tahlequah OK 74464-3338
Phone: (918) 456-7700
Fax: (918) 458-9314
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics 2080P0006X 20370 Oklahoma
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 20370 Oklahoma
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 20370 Oklahoma

Profile Details

NPI number 1386674182
LBN Legal business name Gustavson, Edward Ernest
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 4th, 2006
Last updated Jul 29th, 2013 - about 11 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 1386674182 NPPES
Oklahoma MEDICAID 100173510A

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