Individual
JEAN M. GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
401 N 9TH ST, BISMARCK, ND 58501-4530
(701) 712-4500
(701) 712-4011
Mailing address
401 N 9TH ST, BISMARCK, ND 58501-4530
(701) 712-4524
(701) 712-4205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RL11912
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12083
—
ND
Enumeration date
06/28/2011
Last updated
05/16/2023
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