Provider Demographics
NPI:1336192293
Name:GOSSETT, SHARON ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ELAINE
Last Name:GOSSETT
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 1:4570 CTY. HWY. 61
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-9401
Mailing Address - Country:US
Mailing Address - Phone:218-485-4491
Mailing Address - Fax:218-485-4724
Practice Address - Street 1:4570 CTY. HWY. 61
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9401
Practice Address - Country:US
Practice Address - Phone:218-485-4491
Practice Address - Fax:218-485-4724
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN17-00895OtherMEDICA ONAMIA
MN512S5GOOtherBLUE CROSS CLINIC
MNHP29272OtherHEALTH PARTNERS
MN128084OtherUCARE
MN477648570OtherTRICARE CHAMPUS
MNNA9091020273OtherPREFERRED ONE
MN361S0GOOtherBLUE CROSS HOSPITAL
MN394278300Medicaid
SD7713280Medicaid
MN17-01124OtherMEDICA HILLMAN
MN020001921Medicare ID - Type UnspecifiedHILLMAN
MN020001802Medicare ID - Type UnspecifiedONAMIA
MN394278300Medicaid
MN020003246Medicare PIN
MNNA9091020273OtherPREFERRED ONE