Individual
CAITLIN J. GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
211 FOREST ST, MCCALL, ID 83638
(208) 634-2225
(208) 634-5547
Mailing address
PO BOX 1047, MCCALL, ID 83638-1047
(208) 634-2225
(208) 634-5547
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9146
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157054
BS PLMC
ID
01
—
76664
BC PLMC
ID
05
—
806631600
—
ID
01
—
B6157
BC CMMC
ID
Enumeration date
07/01/2006
Last updated
08/02/2012
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