Provider Demographics
NPI:1457157133
Name:BAAS, MARK ANTHONY FORTES (CDRT(WA-CERT))
Entity type:Individual
Prefix:MR
First Name:MARK ANTHONY
Middle Name:FORTES
Last Name:BAAS
Suffix:
Gender:
Credentials:CDRT(WA-CERT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16302 66TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9025
Mailing Address - Country:US
Mailing Address - Phone:253-355-9486
Mailing Address - Fax:
Practice Address - Street 1:1519 3RD ST SE STE 102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3742
Practice Address - Country:US
Practice Address - Phone:253-841-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WART616184872471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography