Healthcare Provider Details

I. General information

NPI: 1386175180
Provider Name (Legal Business Name): JOSHUA O MARSHAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4238
US

IV. Provider business mailing address

521 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4238
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-2938
  • Fax: 253-403-2968
Mailing address:
  • Phone: 253-403-2938
  • Fax: 253-403-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60971418
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: