Organization
THOMAS C GUSTAFSON
Active
Other names
Market Street Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS CARL GUSTAFSON D.O. (PHYSICIAN)
(206) 782-0500
Entity
Organization
Contact information
Practice address
1717 NW MARKET ST, SEATTLE, WA 98107-5225
(206) 782-0500
(206) 782-0502
Mailing address
1717 NW MARKET ST, SEATTLE, WA 98107-5225
(206) 782-0500
(206) 782-0502
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OP00001187
WA
363LF0000X
Family Nurse Practitioner
AP30007148
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1046325
—
WA
05
—
9647421
—
WA
Enumeration date
04/16/2007
Last updated
07/14/2008
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