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General NPI Number Information
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NPI Number | 1851683635
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Entity Type | Individual
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Provider Name | MARK ALLEN LUNDQUIST MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 200 ANDOVER PARK E STE 8
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City | TUKWILA
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State | WA
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Zip | 98188-2938
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Country | US
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Telephone | 206-575-3136
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Fax | 206-575-4892
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Provider Business Mailing Address
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Address Line | 832 NW 63RD ST
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City | SEATTLE
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State | WA
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Zip | 98107-2212
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Country | US
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Telephone | 503-706-0572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT200993
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 60765772
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License Number State | WA
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