Individual
DR. JOHN BURK GOSSOM
Active
Individual
DR. JOHN BURK GOSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
MD00018422
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
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
—
98250A003
TRIWEST
—
01
—
MD00018422
LICENSE NUMBER
—
Enumeration date
11/02/2005
Last updated
03/04/2011
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