Healthcare Provider Details

I. General information

NPI: 1699716233
Provider Name (Legal Business Name): MARK B EMERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34612 6TH AVE S
FEDERAL WAY WA
98003-6704
US

IV. Provider business mailing address

34612 6TH AVE S #110
FEDERAL WAY WA
98003-8723
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-2594
  • Fax: 253-661-2694
Mailing address:
  • Phone: 253-661-2594
  • Fax: 253-661-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD00037192
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: