Individual
DR. ZACHARY TOMULTY GUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16120 W DODGE RD, OMAHA, NE 68118-2049
(402) 354-0707
(402) 354-0909
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
28647
NE
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
A112799
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026450100
—
NE
05
—
1700053337
—
IA
05
—
47068731742
—
NE
05
—
47068731751
—
NE
05
—
47068731798
—
NE
Enumeration date
05/13/2008
Last updated
08/29/2016
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