Individual
PAUL T. GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
196 ARROWHEAD DR, STE 9, EVANSTON, WY 82930-8752
(307) 783-8280
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2894
IA
208600000X
Surgery Physician
5101015864
MI
208600000X
Surgery Physician
Primary
TL#656
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314100
BCBS
WY
Enumeration date
02/22/2006
Last updated
04/11/2008
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