Edward Ernest Gustavson
MD | Developmental - Behavioral Pediatrics | Male
Edward Ernest Gustavson, MD is a Tahlequah, Oklahoma based Pediatric doctor with medical specialization in
Developmental - Behavioral Pediatrics.
Current practice location of Edward Ernest Gustavson is
1310 E Boone St, Tahlequah, Oklahoma - 74464-3338. He can be contacted on phone at
918-456-7700 and fax number 918-458-9314.
Edward Ernest Gustavson is a sole proprietor of his business.
NPI number (Unique professional ID) for Edward Ernest Gustavson is
1386674182 which was assigned by NPPES on 04 Jul, 2006 and it was last updated on 29 Jul, 2013.
Edward Ernest Gustavson license number is
20370 for Pediatrics Developmental - Behavioral Pediatrics (2080P0006X) in Oklahoma.
Edward Ernest Gustavson is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development.
Complete Profile:
Edward Ernest Gustavson basic information including his official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Developmental - Behavioral Pediatrics |
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| Provider Name : | Edward Ernest Gustavson |
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| Credential : | MD |
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| Gender : | Male |
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Business Address:
Edward Ernest Gustavson address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 1310 E Boone St
Tahlequah, OK, 74464-3338
United States |
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| Phone Number : | 918-456-7700 |
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| Fax Number : | 918-458-9314 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1386674182 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 04 Jul, 2006 |
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| Last Updated On : | 29 Jul, 2013 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Edward Ernest Gustavson are as mentioned. Primary taxonomy code for Edward Ernest Gustavson, MD is
2080P0006X (Pediatrics Developmental - Behavioral Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | No | 20370 | OK |
| 2080N0001X | Pediatrics Neonatal-Perinatal Medicine | No | 20370 | OK |
| 2080P0006X | Pediatrics Developmental - Behavioral Pediatrics | Yes | 20370 | OK |
Legacy Identifiers:
Other legacy medical identifiers of Edward Ernest Gustavson such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
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| 100173510A | MEDICAID | OK | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 1310 E Boone St
Tahlequah, OK, 74464-3338
United States |
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| Phone Number : | 918-456-7700 |
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| Fax Number : | 918-458-9314 |
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Business Location:
Patients can refer following map for directions to
Edward Ernest Gustavson practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.