Individual
MARIA JACOBA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 627-4930
(253) 627-4649
Mailing address
7514 91ST AVE SW, TACOMA, WA 98498-3941
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00021425
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015353
—
WA
01
—
50110
L&I
—
01
—
MA5314
B/S REGENCE 90
—
Enumeration date
07/11/2006
Last updated
07/08/2007
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