Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 5388-15 | WI |
Y | 1223P0106X | Oral and Maxillofacial Pathology | D10642 | MN |
NPI | 1841252996 |
---|---|
Provider Name | Dr. Mark Richard Gleisner |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 28/01/2010 |