Provider Demographics
NPI:1750323291
Name:TUSSING, GORDON PAUL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:PAUL
Last Name:TUSSING
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4643 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4551
Mailing Address - Country:US
Mailing Address - Phone:716-839-9113
Mailing Address - Fax:716-839-3771
Practice Address - Street 1:4643 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4551
Practice Address - Country:US
Practice Address - Phone:716-839-9113
Practice Address - Fax:716-839-3771
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1581909OtherCOMMERCIAL INSURANCE
NY0410988OtherINDEPENDENT HEALTH ASSOC.
NY00025069501OtherUNIVERA HEALTH CARE
NY005260131OtherBLUE CROSS
NYCC0924Medicare ID - Type Unspecified
NY16-1581909OtherCOMMERCIAL INSURANCE