Provider Demographics
NPI:1053502096
Name:GUSTAFSON, WILLIAM CLAY (MD/PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLAY
Last Name:GUSTAFSON
Suffix:
Gender:M
Credentials:MD/PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE # M647
Mailing Address - Street 2:UCSF PEDIATRIC HEMATOLOGY/ONCOLOGY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-476-3831
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE # M647
Practice Address - Street 2:UCSF PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1034642080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology