Individual
DR. GUSTAVO HUERTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
704 E COLLEGE ST, DICKSON, TN 37055-2032
(615) 441-4504
(615) 446-1357
Mailing address
127 CRESTVIEW PARK DR, DICKSON, TN 37055-2855
(615) 446-5121
(615) 446-1357
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD22062
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020047462
RAILROAD MEDICARE
—
05
—
3066526
—
TN
01
—
3158146
BLUE CROSS BLUE SHIELD TN
TN
Enumeration date
05/23/2005
Last updated
02/02/2012
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