Individual
MARK E COUGHENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1717 13TH ST, SUITE 300, EVERETT, WA 98201-1621
(425) 297-5500
(425) 297-5514
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD00025571
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0211179
LABOR AND INDUSTRY
WA
05
—
1018272
—
WA
01
—
110073395
RAILROAD MEDICARE
—
05
—
8108839
—
WA
01
—
MD00025571
STATE LICENSE NUMBER
WA
Enumeration date
06/06/2006
Last updated
12/06/2012
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