MEDICARE: CRAIG ALLEN GUSTAFSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	41250	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00141399	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013093517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALLEN GUSTAFSON MD

Provider Business Mailing Address
First Line	:	PO BOX 6971
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-0971
Country	:	US
Telephone Number	:	402-486-7020
Fax Number	:	402-434-6037

Provider Business Practice Location Address
First Line	:	2478 PATTERSON RD
Second Line	:	SUITE 27
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1266
Country	:	US
Telephone Number	:	970-242-1566
Fax Number	:	970-263-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/31/2008

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