Healthcare Provider Details

I. General information

NPI: 1992800478
Provider Name (Legal Business Name): ROBERT LEE GUSTOFSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HEALTH PARK DR STE 240
LOUISVILLE CO
80027-4644
US

IV. Provider business mailing address

10290 RIDGEGATE CIR
LONE TREE CO
80124-5331
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-0150
  • Fax: 303-665-0740
Mailing address:
  • Phone: 303-788-8300
  • Fax: 303-788-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number44305
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: