Individual
DR. MARK DALE NELLERMOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
3929 BRIDGEPORT WAY W STE 308, UNIVERSITY PLACE, WA 98466-4455
(253) 627-4181
(253) 272-5922
Mailing address
3929 BRIDGEPORT WAY W STE 308, UNIVERSITY PLACE, WA 98466-4455
(253) 627-4181
(253) 272-5922
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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