Individual
KURT JOSEPH GUSTAFSON
Active
Individual
KURT JOSEPH GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
SC004598L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008247770003
—
PA
01
—
2811707
AETNA NO
PA
01
—
480033403
RAILROAD MEDICARE
PA
01
—
50000307
BLUE CROSS
PA
01
—
80426
GEISINGER
PA
01
—
815699
1ST PRIORITY
PA
Enumeration date
07/21/2006
Last updated
06/21/2011
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