Individual
MARK JOHNATHAN SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
720 W MAIN ST, BATTLE GROUND, WA 98604-4406
(360) 687-6513
Mailing address
29212 NE 132ND AVE, BATTLE GROUND, WA 98604-7576
(541) 654-1505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60167537
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0266346
L & I
WA
Enumeration date
05/22/2007
Last updated
09/14/2018
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