Individual
GAVIN J UDSTUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 GOODMAN ST, DEPT. OF RADIOLOGY, CINCINNATI, OH 45267-1000
(513) 584-7544
(513) 584-9100
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 245-3107
(513) 585-5511
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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