Individual
DR. MARK AARON BROADBENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2502 S UNION AVE, TACOMA, WA 98405-1328
(253) 841-4653
(253) 446-3973
Mailing address
1304 FAWCETT AVE STE 100, TACOMA, WA 98402-1900
(253) 761-4200
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
MD188795
OR
2085N0700X
Neuroradiology Physician
MD60837429
WA
2085R0202X
Diagnostic Radiology Physician
2017008637
MO
2085R0202X
Diagnostic Radiology Physician
MD188795
OR
2085R0202X
Diagnostic Radiology Physician
Primary
MD60837429
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0389196
LNI-TRA REST OF WA
WA
01
—
0389197
LNI-TRA KING COUNTY
WA
01
—
0389198
LNI-UAOM
WA
01
—
0389199
LNI-DINW
WA
05
—
2097736
—
WA
05
—
500744919
—
OR
Enumeration date
06/22/2012
Last updated
04/25/2024
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