Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD60034383 | WA |
N | 2080P0214X | Pediatric Pulmonologist | H9272 | TX |
NPI | 1679533251 |
---|---|
Provider Name | Mark R Solomon |
First Address | Puyallup, WA 98372-3770 |
Second Address | Puyallup, WA 98372-3770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 06/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0068PT | BCBS (01) | TX |
136293110 | (05) | TX |
136293112 | (05) | TX |
F67253 | (02) | TX |