Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD00026270 | WA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD00026270 | WA |
NPI | 1326119322 |
---|---|
Provider Name | Mark C. Dales |
First Address | Seattle, WA 98145-5005 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 09/06/2011 |