Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Tyler Joseph Gustafson, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1609543255

Mr. Tyler Joseph Gustafson, PHYSICIANASSISTANT is a Physician Assistant in Jamestown, New York. Qualified in 2021, 5 years ago. Practices with Great Lakes Physician Practice PC, a 143-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
5
Licensed in
NY
In the registry since
2021
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

15 S Main St
Jamestown, NY 14701-6626
Phone: (716) 969-4235
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 026970 (NY)

Record details

NPI number1609543255
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorYes
NPI enumeratedAugust 23, 2021
Last updated in NPPESFebruary 7, 2023
Certification dateFebruary 7, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Great Lakes Physician Practice Pc — 143 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Jamestown