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Individual
DR. MARK DALE NELLERMOE
Active
Individual
DR. MARK DALE NELLERMOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO00000507
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039635
DEPARTMENT OF LABOR & IND
WA
05
—
1102375
—
WA
01
—
1386733541
NPI #
WA
01
—
990007694
RAILROAD MEDICARE ID
WA
01
—
GAB02027
MEDICARE ID
WA
Enumeration date
10/12/2006
Last updated
07/11/2011
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