Individual
DR. MARK IAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 S KITSAP BLVD STE 210, PORT ORCHARD, WA 98366-3738
(360) 895-8950
(360) 895-8980
Mailing address
450 S KITSAP BLVD STE 210, PORT ORCHARD, WA 98366-3738
(360) 895-8950
(360) 895-8980
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01053155A
IN
208800000X
Urology Physician
Primary
MD60194935
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2011203
—
WA
Enumeration date
02/09/2006
Last updated
11/12/2020
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