Individual
DR. STACY ELIZABETH GUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4840 E INDIAN SCHOOL RD, SUITE 100, PHOENIX, AZ 85018-5500
(480) 882-7360
(602) 952-9432
Mailing address
4840 E INDIAN SCHOOL RD, SUITE 100, PHOENIX, AZ 85018-5500
(480) 882-7360
(602) 840-4250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4643
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z124486
MEDICARE PTAN
AZ
Enumeration date
01/10/2008
Last updated
09/25/2014
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