Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT60228289 | WA |
Y | 213ES0000X | Sports Medicine | PT60228289 | WA |
NPI | 1043596679 |
---|---|
Provider Name | Mr. Anthony Michael Mark |
First Address | Seattle, WA 98101-2735 |
Second Address | Seattle, WA 98101-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2011 |
Last Update Date | 27/10/2011 |