Individual
MARK KORTBAOUI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
320 W 10TH AVE STE 202, KENNEWICK, WA 99336-6302
(509) 221-5520
Mailing address
909 NE 110TH AVE, PORTLAND, OR 97220-3134
(908) 943-6247
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP61564493
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2019
Last updated
10/09/2024
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