Tracy Lee Gustafson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G2143 Issued in TX

Practice address

151 Rainbow Dr
Apt #5152
Livingston, TX 77399-1571

Phone

(936) 933-9593

Fax

(281) 715-3202

NPI assigned

Oct 28, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397347200000",
    "number": "1295035863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 RAINBOW DR",
            "address_2": "APT #5152",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773991571",
            "telephone_number": "936-933-9593",
            "fax_number": "281-715-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 RAINBOW DR",
            "address_2": "APT #5152",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773991571",
            "telephone_number": "936-933-9593",
            "fax_number": "281-715-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "TRACY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-28",
        "last_updated": "2014-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "G2143",
            "primary": true
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "TX",
            "license": "G2143",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Francis Griffin, MSPT
• Anna Grimmett
• Jeancarlo Antonio Guerrero
• Ayaba Guiste, D.D.S.
• Clara Gulley, DDS
• Jessica Haffner
• Harbor Home Health LP
• Harbor Hospice of Livingston LP
• Isabelle Harpey
• Stacey Leigh Harris Akers, ENP, FNP

• Pediatrics Physician in Livingston, TX
• Providers in Livingston, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.