Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00025677 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD00025677 | WA |
NPI | 1225118201 |
---|---|
Provider Name | John Mark Beard |
First Address | Everett, WA 98206-5127 |
Second Address | Mukilteo, WA 98275-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 15/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0230703 | L&I (01) | WA |
1005385 | (05) | WA |
1225118201 | (05) | WA |
2005974 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
E80574 | (02) |