Individual
MARK R SOLOMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
407 14TH AVE SE, PUYALLUP, WA 98372-3770
(253) 697-4110
Mailing address
407 14TH AVE SE, PUYALLUP, WA 98372-3770
(253) 697-4110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD60034383
WA
2080P0214X
Pediatric Pulmonology Physician
H9272
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068PT
BCBS
TX
05
—
136293110
—
TX
05
—
136293112
—
TX
Enumeration date
03/27/2006
Last updated
05/06/2011
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