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Individual

MARK D CORAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
401 W POPLAR ST, PSMPG SLEEP MEDICINE, WALLA WALLA, WA 99362-2846
(509) 522-5845
(509) 522-5527
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60118218
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1407184021
WA
05
500629795
OR
Enumeration date
11/19/2009
Last updated
05/10/2021
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