Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A85025 | CA |
N | 204C00000X | Sports Medicine Doctor | MD00046384 | WA |
N | 207Q00000X | Family Doctor | A85025 | CA |
N | 207Q00000X | Family Doctor | MD00046384 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | A85025 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD00046384 | WA |
N | 2081S0010X | Sports Medicine | MD00046384 | WA |
N | 213ES0000X | Sports Medicine | MD00046384 | WA |
NPI | 1972581114 |
---|---|
Provider Name | Mark R Mariani |
First Address | Tacoma, WA 98405-2433 |
Second Address | Tacoma, WA 98405-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 30/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I08769 | (02) |