EDWARD ERNEST GUSTAVSON

TAHLEQUAH, OK
NPI1386674182
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2080P0006X Pediatrics, Developmental - Behavioral Pediatrics
(Licence: OK  20370)
Additional Taxonomies208000000X Pediatrics
(Licence: OK  20370)
2080N0001X Pediatrics, Neonatal-Perinatal Medicine
(Licence: OK  20370)
Enumeration Date2006-07-04
Last Update Date2013-07-29
Business Address
-- EDWARD ERNEST GUSTAVSON MD
1310 E BOONE ST
TAHLEQUAH, OK 74464-3338
Phone number: 918-456-7700
Mailing Address
-- EDWARD ERNEST GUSTAVSON MD
1310 E BOONE ST
TAHLEQUAH, OK 74464-3338
Phone number: 918-456-7700