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1717 Nw Market St Seattle WA 98107-5225 | |
| (206) 782-0500 | |
| (206) 782-0502 |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 1717 Nw Market St, Seattle, Washington |
| Authorized Official Name and Position | Thomas Carl Gustafson (PHYSICIAN) |
| Authorized Official Contact | 2067820500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1717 Nw Market St Seattle WA 98107-5225 Ph: (206) 782-0500 | 1717 Nw Market St Seattle WA 98107-5225 Ph: (206) 782-0500 |
| NPI Number | 1821213612 |
|---|---|
| Provider Enumeration Date | 04/16/2007 |
| Last Update Date | 07/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821213612 | NPI | - | NPPES |
| 9647421 | Medicaid | WA | |
| 1046325 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | OP00001187 (Washington) | Primary |
| 363LF0000X | Nurse Practitioner - Family | AP30007148 (Washington) | Secondary |
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