MEDICARE: DR. MARK WALTER LAYTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	MD00024518	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12371	OTHER	WA	L&I NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891846077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WALTER LAYTON M.D.

Provider Business Mailing Address
First Line	:	1212 HARRISON AVE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5466
Country	:	US
Telephone Number	:	360-754-6700
Fax Number	:	360-754-0164

Provider Business Practice Location Address
First Line	:	1212 HARRISON AVE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5466
Country	:	US
Telephone Number	:	360-754-6700
Fax Number	:	360-754-0164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/09/2007

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