Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
EDWARD ERNEST GUSTAVSON, MD
ActiveEDWARD ERNEST GUSTAVSON, MD is a Developmental-Behavioral Pediatrics healthcare provider located in TAHLEQUAH, Oklahoma. NPI 1386674182 is currently active in the NPPES registry. Verify at CMS.
Developmental-Behavioral Pediatrics · TAHLEQUAH, OK
Registration Details
- NPI Number
- 1386674182
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 4, 2006 (20.131407942262 yrs)
- Last Updated
- Jul 29, 2013
- Licenses
-
20370 (OK)20370 (OK)20370 (OK)
Practice Information
- Address
-
1310 E BOONE STTAHLEQUAH, OK, 744643338Browse OK providers · Browse ZIP 74464
- Phone
- 9184567700
- Fax
- 9184589314
- Primary Specialty
-
Developmental-Behavioral Pediatrics
2080P0006X
- Additional Specialty
- Pediatrics
- Additional Specialty
- Neonatal-Perinatal Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.