Individual
DR. MARK J WALISER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
174 FIRST AVENUE NORTH, ILWACO, WA 98624-0258
(360) 642-3181
Mailing address
PO BOX H, ILWACO, WA 98624-0258
(360) 642-3181
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00025170
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104152
—
WA
01
—
25713
L & I
WA
Enumeration date
07/16/2006
Last updated
07/08/2007
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