Individual
DR. JONATHAN GUSDORFF
Active
Individual
DR. JONATHAN GUSDORFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OS010370L
PA
2085N0700X
Neuroradiology Physician
02005865A
IN
2085R0202X
Diagnostic Radiology Physician
4519
OK
2085R0202X
Diagnostic Radiology Physician
Primary
OS010370L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200114580A
—
OK
Enumeration date
06/30/2005
Last updated
11/21/2019
Update your record
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