Healthcare Provider Details

I. General information

NPI: 1235527110
Provider Name (Legal Business Name): DUSTIN J GEBUR MSED, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W 44TH PL
SIOUX FALLS SD
57105-6376
US

IV. Provider business mailing address

1601 W 44TH PL
SIOUX FALLS SD
57105-6376
US

V. Phone/Fax

Practice location:
  • Phone: 605-201-6671
  • Fax:
Mailing address:
  • Phone: 605-201-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0318
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: