Organization
SAN JUAN HEALTHCARE ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BURK GOSSOM M.D. (MEMBER MANAGER)
(360) 378-1338
Entity
Organization
Contact information
Practice address
689 AIRPORT CENTER, STE B, FRIDAY HARBOR, WA 98250
(360) 378-1338
(360) 378-1830
Mailing address
PO BOX 1550, FRIDAY HARBOR, WA 98250-1550
(360) 378-1338
(360) 378-1830
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152516
LABOR AND INDUSTRIES
—
01
—
7108681
DSHS MEDICAID
—
01
—
8937841
CRIME VICTIMS
—
01
—
9451SA
REGENCE BLUE SHIELD
—
01
—
J5122
RAILROAD MEDICARE
—
Enumeration date
12/09/2005
Last updated
09/11/2025
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