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Individual

GAVIN J UDSTUEN

Active
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Individual

GAVIN J UDSTUEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35-07-1170
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000228669
ANTHEM
OH
01
1603249
UNITED HEALTHCARE
OH
05
1805944000
WV
05
200411300A
IN
05
2214857
OH
01
2903618
AETNA
OH
01
300134540
RAILROAD MEDICARE
OH
05
64028558
KY
Enumeration date
07/07/2006
Last updated
02/21/2018
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