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General NPI Number Information
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NPI Number | 1639339096
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Entity Type | Individual
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Provider Name | CHRIS OLAF GUSTAFSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 200 ABRAHAM FLEXNER WAY
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City | LOUISVILLE
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State | KY
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Zip | 40202-2877
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Country | US
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Telephone | 502-587-4404
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Fax | 502-587-4156
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Provider Business Mailing Address
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Address Line | PO BOX 35147
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City | SEATTLE
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State | WA
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Zip | 98124-5147
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Country | US
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Telephone | 503-299-9906
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Fax | 503-225-9002
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 57886
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | TP347
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD28282
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 258492
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License Number State | NY
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