Individual
DR. KURT GUSTAVSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6216 WHISPER LN SW, LAKEWOOD, WA 98499-1139
(253) 968-1613
Mailing address
6216 WHISPER LN SW, LAKEWOOD, WA 98499-1139
(253) 968-1613
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
99
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99
STATE LICENSE
MT
Enumeration date
04/20/2007
Last updated
07/08/2007
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