Provider Demographics
NPI:1790763175
Name:GUSTY, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:GUSTY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:ANDREW JAMES GUSTY MD PLLC
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5260
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:ANDREW JAMES GUSTY MD PLLC
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0056133207R00000X, 208M00000X
AZ35501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI42552Medicare UPIN