| | Physician Last Name: | Gustafson |
| | Physician First Name: | Thomas |
| | Physician Middle Name: | R |
| | Address: | 1243 Pennsylvania Avenue
Pine City, NY 14871 |
| | License Number: | 186217 |
| | License Type: | MD |
| | Year of Birth: |
1956
|
| | Effective Date: | 12/23/2013 |
| | Action Description for DOH Webpage: | Censure and reprimand, $1000 fine and the physician must complete the victim impact panel and the New York Drinking Driver Program.The physician completed the terms of his order effectve March 21, 2014. |
| | Misconduct Description for DOH Webpage: | The physician did not contest the charge of having been convicted in the Southport Town Court, Chemung County, New York of Driving While Intoxicated. |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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