Organization
SAN JUAN HEALTHCARE ASSOCIATES PLLC
Active
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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