Individual
RICHARD E GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4600 VALLEY ROAD, SUITE 200, LINCOLN, NE 68510-4844
(402) 483-4571
(402) 483-5079
Mailing address
4600 VALLEY ROAD, SUITE 200, LINCOLN, NE 68510-4844
(402) 483-4571
(402) 483-5079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17912
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080120246
RAILROAD MEDICARE
NE
05
—
47055301100
—
NE
Enumeration date
04/17/2006
Last updated
04/02/2008
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