| NPI | 1821213612 |
|---|---|
| Doing Business As | MARKET STREET CLINIC |
| Entity Type | Organization |
| Authorized Contact | THOMAS CARL GUSTAFSON Physician 206-782-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA OP00001187) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30007148) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-07-14 |