| Organization Name: | SAN JUAN HEALTHCARE PC |
| NPI Number: | 1407055742 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN BURK GOSSOM (OWNER) |
| Mailing Address: | 689 Airport Center Dr Suite B Friday Harbor |
| State: | WA US |
| Postal Code: | 98250 |
| Phone Number: | 3603781338 |
| Fax Number: | 3603788130 |
| NPI Enumeration Date: | 07/17/2007 |
| NPI Last Update Date: | 03/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |