| Paul T Gustafson, DO | |
|
196 Arrowhead Dr, Ste 9, Evanston, WY 82930-8752 | |
| (307) 783-8280 | |
| Not Available |
| Full Name | Paul T Gustafson |
|---|---|
| Gender | Male |
| Speciality | Surgery |
| Location | 196 Arrowhead Dr, Evanston, Wyoming |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528033644 | NPI | - | NPPES |
| 314100 | Other | WY | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | TL#656 (Wyoming) | Primary |
| 208600000X | Surgery | 2894 (Iowa) | Secondary |
| 208600000X | Surgery | 5101015864 (Michigan) | Secondary |
| Entity Name | Signify Health Medical Associates Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750845863 PECOS PAC ID: 2163764424 Enrollment ID: O20190507001451 |
| Mailing Address | Practice Location Address |
|---|---|
| Paul T Gustafson, DO 7100 Commerce Way, Suite 180, Brentwood, TN 37027-2829 Ph: (615) 465-7000 | Paul T Gustafson, DO 196 Arrowhead Dr, Ste 9, Evanston, WY 82930-8752 Ph: (307) 783-8280 |
Dr. Jared Breck Barton, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 191 Overthrust Rd, Evanston, WY 82930 Phone: 307-789-8721 Fax: 307-789-8664 | |
Dr. Gregory M Yasuda, MD Surgery Medicare: Medicare Enrolled Practice Location: 75 Yellow Creek Rd Ste 101, Evanston, WY 82930 Phone: 307-789-7777 Fax: 307-789-8888 | |
Ian James Kendrick, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 190 Arrowhead Dr, Evanston, WY 82930 Phone: 307-783-8255 Fax: 307-783-8167 |