Individual
MARK WILLIAM ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34509 9TH AVE S, STE 208, FEDERAL WAY, WA 98003-6700
(253) 944-3278
(253) 944-4345
Mailing address
34509 9TH AVE S, STE 208, FEDERAL WAY, WA 98003-6700
(253) 944-3278
(253) 944-4345
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G72120
CA
208600000X
Surgery Physician
Primary
MD00033523
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G721201
—
CA
01
—
0281815
STATE L&I
WA
01
—
0281816
STATE L&I
WA
01
—
0290078
STATE L&I
WA
01
—
33523
WASHINGTON LICENSE
WA
01
—
G72120
CALIFORNIA STATE LICENSE
CA
Enumeration date
04/17/2006
Last updated
03/07/2023
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