Healthcare Provider Details

I. General information

NPI: 1689620320
Provider Name (Legal Business Name): MARK J. EVERARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 PINE ST STE 300
SEATTLE WA
98101
US

IV. Provider business mailing address

1216 PINE ST STE 300
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-1768
  • Fax: 206-323-2184
Mailing address:
  • Phone: 206-323-1768
  • Fax: 206-323-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00042194
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00042194
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD00042194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: