Dr. Tracy Lee Gustafson, M.D.
Pediatrics in Livingston, TX. Individual provider (NPI-1).
NPI number1295035863
StatusActive
Last updated in NPPESApr 13, 2014
Details
- NPI
- 1295035863
- Entity type
- Individual (NPI-1)
- Name
- Dr. Tracy Lee Gustafson
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 28, 2010
- Last updated
- Apr 13, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | G2143 | TX | Yes |
| 2083P0901X | Preventive Medicine, Public Health & General Preventive Medicine | G2143 | TX |
Practice location
151 Rainbow DrApt #5152
Livingston, TX 77399-1571
Phone 936-933-9593 · Fax 281-715-3202
Mailing address
151 Rainbow DrApt #5152
Livingston, TX 77399-1571
Phone 936-933-9593 · Fax 281-715-3202
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Pediatrics Physician providers in Livingston, TX
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All 9 Pediatrics Physician providers in Livingston · All 487 providers in Livingston
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