Individual
DR. PAUL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
398 NEPONSET AVE, DORCHESTER, MA 02122-3134
(617) 282-3200
(617) 282-8201
Mailing address
1135 MORTON ST, MATTAPAN, MA 02126-2834
(617) 533-2300
(617) 282-8201
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
41092
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2052792
—
MA
Enumeration date
12/13/2005
Last updated
02/04/2013
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