Provider Demographics
NPI:1760942304
Name:ROSSI, GUSTAVE JOHN JR (MD)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVE
Middle Name:JOHN
Last Name:ROSSI
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3390 N CAMPBELL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 N. TENAYA WAY
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0431
Practice Address - Country:US
Practice Address - Phone:702-962-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ69682207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008885600OtherHOMETOWN HEALTH