Provider Demographics
NPI:1730309147
Name:GUSTAFSON, BELINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:J
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 LAKE CITY WAY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6748
Mailing Address - Country:US
Mailing Address - Phone:206-461-3614
Mailing Address - Fax:206-634-0094
Practice Address - Street 1:11000 LAKE CITY WAY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6748
Practice Address - Country:US
Practice Address - Phone:206-461-3614
Practice Address - Fax:206-634-0094
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000316672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1097450Medicaid
WABO3484932OtherDEA NUMBER
WABO3484932OtherDEA NUMBER
WA217126005Medicare ID - Type UnspecifiedCPC MEDICARE -CITY CENTER
WA217126205Medicare ID - Type UnspecifiedCPC MEDCIARE -NORTHGATE
WA217125805Medicare ID - Type UnspecifiedCPC MEDICARE NUMBER -BELL
WA217126305Medicare ID - Type UnspecifiedCPC MEDICARE -4120