Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | MD00019557 | WA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD00019557 | WA |
NPI | 1043202450 |
---|---|
Provider Name | Mark C Adams |
First Address | Bremerton, WA 98310-3351 |
Second Address | Bremerton, WA 98310-3351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011459 | L AND I (01) | WA |
1014067 | (05) | WA |
91110658904 | KPS (01) | WA |
A03947 | (02) | |
AD0732 | REGENCE (01) | WA |