National Provider Identifier
Tyler Joseph Gustafson, PHYSICIAN ASSISTANT
Tyler Joseph Gustafson, PHYSICIAN ASSISTANT is listed in the NPPES registry with a primary specialty of Physician Assistant in Jamestown, NY and a listed phone number of (716) 969-4235.
Profile Overview
- NPI
- 1609543255
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- August 23, 2021
- Last Updated
- February 07, 2023
Practice Location
- 15 S Main St
- Jamestown, NY 14701-6626
Phone: (716) 969-4235
Mailing Address
- 390 East Fairmount Ave.
- Lakewood, NY 14750
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1609543255
- Entity Type
- Individual
- Last Name
- Gustafson
- First Name
- Tyler
- Middle Name
- Joseph
- Name Prefix
- Mr.
- Credential
- PHYSICIAN ASSISTANT
- Mailing Street Address
- 390 East Fairmount Ave.
- Mailing City
- Lakewood
- Mailing State
- NY
- Mailing ZIP Code
- 14750
- Mailing Country
- US
- Mailing Phone
- (716) 526-0156
- Practice Street Address
- 15 S Main St
- Practice City
- Jamestown
- Practice State
- NY
- Practice ZIP Code
- 14701-6626
- Practice Country
- US
- Practice Phone
- (716) 969-4235
- Enumeration Date
- August 23, 2021
- Last Updated
- February 07, 2023
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- February 07, 2023
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)