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Individual

MARK THOMAS HATTENHAUER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2730
(360) 414-2739
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2730
(360) 414-2739

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD00028883
WA
207RC0000X
Cardiovascular Disease Physician
Primary
MD07556
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
085084
OR
05
8563314
WA
Enumeration date
07/31/2006
Last updated
04/08/2010
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