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Individual
DR. ROBERT GUSTAFSON
Active
Individual
DR. ROBERT GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
11159
WV
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
11159
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128544000
—
WV
01
—
330004835
RAILROAD MEDICARE
WV
Enumeration date
09/20/2006
Last updated
04/13/2022
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