Healthcare Provider Details

I. General information

NPI: 1326119322
Provider Name (Legal Business Name): MARK C. DALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE DEPARTMENT OF ORTHOPEDICS AND SPORTS MEDICINE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

M/S W7706 PO BOX 5371 4800 SAND POINT WAY NE
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2109
  • Fax:
Mailing address:
  • Phone: 206-987-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00026270
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD00026270
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: