IndividualActive
Edward Gustavson, MD
NPI 1386674182 · Developmental - Behavioral Pediatrics Physician · Tahlequah, OK
Provider details
- NPI number
- 1386674182
- Entity type
- Individual
- Primary specialty
- Developmental - Behavioral Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 20370 (OK)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
1310 E Boone St
Tahlequah, OK 74464-3338
Phone: (918) 456-7700
Fax: (918) 458-9314
Approximate (ZIP-level) locationGet directions
Mailing address
1310 E Boone St
Tahlequah, OK 74464-3338
Registry dates
- Enumerated
- 2006-07-04
- Last updated
- 2013-07-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.