Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | P000000173 | WA |
N | 213ES0131X | Foot Surgery | P000000173 | WA |
NPI | 1205846755 |
---|---|
Provider Name | Dr. Mark A Alenick |
First Address | Tacoma, WA 98499-2751 |
Second Address | Tacoma, WA 98499-2751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 16/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1016807 | (05) | WA |
14246 | L & I # (01) | WA |
T02645 | (02) | WA |