Gustavson, Paul Russell
Gustavson, Paul Russell is an individual health care provider with primary practice located at 2826 Harris St , Eureka CA 95503-4809. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Gustavson, Paul Russell can be contacted via phone (707) 443-8066.Contact Information
Primary practice address
2826 Harris St
Eureka CA 95503-4809
Phone: (707) 443-8066
Fax: (707) 268-3250
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA17059 | California |
Profile Details
| NPI number | 1295754752 |
|---|---|
| LBN Legal business name | Gustavson, Paul Russell |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 18th, 2006 |
| Last updated | Nov 2nd, 2021 - about 4 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 | 1295754752 | NPPES |
| California | MEDICAID | 0PA170590 |
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