Individual
DR. GARY L. GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8015 E. 171ST ST., BELTON, MO 64012
(816) 331-0961
(816) 322-5236
Mailing address
8015 E. 171ST ST., BELTON, MO 64012
(816) 331-0961
(816) 322-5236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R8612
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240300806
—
MO
Enumeration date
12/09/2005
Last updated
08/24/2010
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