Healthcare Provider Details

I. General information

NPI: 1407848559
Provider Name (Legal Business Name): MARK A SCHOMOGYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 104
TACOMA WA
98405-5303
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 104
TACOMA WA
98405-5303
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6739
  • Fax:
Mailing address:
  • Phone: 253-426-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00032064
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number100163-875
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number102896
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD00032064
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: