Dr. John Burk Gossom
Family Doctor - Geriatric Medicine
689 Airport Center Dr Ste B
Friday Harbor
, Washington 98250
Dr. John Burk Gossom
Family Doctor - Geriatric Medicine
689 Airport Center Dr Ste B
Friday Harbor
, Washington 98250
(360) 378-1830
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About
Features
Specialties
- Family Doctor - Geriatric Medicine
Languages spoken
- English
Location
First Address
- Dr. John Burk Gossom
- Po Box 1550
- Friday Harbor, WA
- Zip : 98250-1550
- Fax : (360) 378-1830
- Phone : (360) 378-1338
Second Address
- Dr. John Burk Gossom
- 689 Airport Center Dr Ste B
- Friday Harbor, WA
- Zip : 98250
- Fax : (360) 378-1830
- Phone : (360) 378-1338
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD00018422 | WA |
National Provider Identifier
| NPI | 1245221886 |
|---|---|
| Provider Name | Dr. John Burk Gossom |
| First Address | Friday Harbor, WA 98250-1550 |
| Second Address | Friday Harbor, WA 98250 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/11/2005 |
| Last Update Date | 04/03/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0152514 | LABOR AND INDUSTRIES (01) | |
| 361929500 | US DEPT OF LABOR (01) | |
| 532300001 | GROUP HEALTH (01) | |
| 5403470 | CCN (01) | |
| 5877GO | REGENCE BLUE SHIELD (01) | |
| 8101404 | DSHS (01) | |
| 8937843 | CRIME VICTIMS (01) | |
| 912109329 | CIGNA BEECH ST (01) | |
| 912109329 | COMMUNITY HEALTHPLAN OF W (01) | |
| 912109329 | FIRST CHOICE (01) | |
| 912109329 | PREMERA BLUE CROSS (01) | |
| 912109329 | TAX ID (01) | |
| 912109329 | TRIWEST (01) | |
| 98250A003 | TRIWEST (01) | |
| E17984 | (02) | |
| MD00018422 | LICENSE NUMBER (01) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.