Provider Demographics
NPI:1194708552
Name:GUSTAFSON, CYNTHIA J (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:J
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-288-2400
Mailing Address - Fax:772-419-0155
Practice Address - Street 1:1050 SE MONTEREY RD STE 303
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-288-2400
Practice Address - Fax:772-419-0143
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME46148207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD86133Medicare UPIN
FL61450ZMedicare ID - Type Unspecified