Organization
GAY L GUSTAFSON DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAY L GUSTAFSON DPM (OWNER)
(505) 299-4487
Entity
Organization
Contact information
Practice address
7700 MENAUL BLVD NE, STE D, ALBUQUERQUE, NM 87110-4616
(505) 299-4487
(505) 299-4498
Mailing address
7700 MENAUL BLVD NE, STE D, ALBUQUERQUE, NM 87110-4616
(505) 299-4487
(505) 299-4498
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
252
NM
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q4698
—
NM
Enumeration date
01/12/2012
Last updated
03/30/2023
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