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General NPI Number Information
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NPI Number | 1386149391
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Entity Type | Individual
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Provider Name | CHASE WILLIAM GULSTROM DO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1000 GREG KRUSCHEK AVENUE
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City | NOME
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State | AK
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Zip | 99762
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Country | US
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Telephone | 190-744-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 CITY OF NOME DRIVE, BOX 1242
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City | NOME
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State | AK
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Zip | 99762
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Country | US
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Telephone | 808-228-0886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 146077
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 185188
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License Number State | AK
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