Healthcare Provider Details

I. General information

NPI: 1467574863
Provider Name (Legal Business Name): MARK URMANSKI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MARTIN WAY E SUITE 108
OLYMPIA WA
98506-5052
US

IV. Provider business mailing address

3700 MARTIN WAY E SUITE 108
OLYMPIA WA
98506-5052
US

V. Phone/Fax

Practice location:
  • Phone: 360-923-5565
  • Fax: 360-923-5643
Mailing address:
  • Phone: 360-923-5565
  • Fax: 360-923-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number11450
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAU11450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: