Individual
MARK R FICKERT
Active
Individual
MARK R FICKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA382
ID
363AM0700X
Medical Physician Assistant
PA10004192
WA
363AS0400X
Surgical Physician Assistant
Primary
PA10004192
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8348484
—
WA
01
—
P00231292
RAILROAD MCR
—
01
—
PA382
LICENSE
ID
Enumeration date
08/16/2006
Last updated
10/13/2022
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