# THOMAS C GUSTAFSON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Market Street Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821213612
- **Authorized official:** DR. THOMAS CARL GUSTAFSON D.O. (PHYSICIAN)
- **Authorized official phone:** (206) 782-0500

## Contact information

- **Practice address:** 1717 NW MARKET ST, SEATTLE, WA 98107-5225
- **Practice address phone:** (206) 782-0500
- **Practice address fax:** (206) 782-0502
- **Mailing address:** 1717 NW MARKET ST, SEATTLE, WA 98107-5225
- **Mailing address phone:** (206) 782-0500
- **Mailing address fax:** (206) 782-0502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | OP00001187 | WA | Yes |
| 363LF0000X | Family Nurse Practitioner | AP30007148 | WA | — |

## Other

- **Enumeration date:** 04/16/2007
- **Last updated:** 07/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1046325 | — | WA |
| 05 | — | 9647421 | — | WA |