MEDICARE: MR. GUSTAVE JOHN ROSSI JR. 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	207L00000X	Anesthesiology Physician	69682	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0008885600	OTHER		HOMETOWN HEALTH

General Provider Information

NPI Number	:	1760942304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUSTAVE JOHN ROSSI JR. MD

Provider Business Mailing Address
First Line	:	3390 N CAMPBELL AVE STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 N. TENAYA WAY
Second Line	:	GRADUATE MEDICAL EDUCATION
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0431
Country	:	US
Telephone Number	:	702-962-5634
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	09/06/2023

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