Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5913 | WA |
Y | 213EG0000X | General Practice | 5913 | WA |
NPI | 1003855644 |
---|---|
Provider Name | Mark R Soltys |
First Address | Bainbridge Island, WA 98110-2463 |
Second Address | Bainbridge Island, WA 98110-2463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07108 | INSURANCE PROVIDER (01) | WA |
4104SO | INSURANCE PROVIDER (01) | WA |
5100201 | (05) | WA |