Provider Demographics
NPI:1699736942
Name:SNELL, MARK JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JONATHAN
Last Name:SNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 5TH ST SE
Mailing Address - Street 2:STE 4300
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4511
Mailing Address - Country:US
Mailing Address - Phone:253-697-4649
Mailing Address - Fax:253-697-4744
Practice Address - Street 1:1450 5TH ST SE
Practice Address - Street 2:STE 4300
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4511
Practice Address - Country:US
Practice Address - Phone:253-697-4649
Practice Address - Fax:253-697-4744
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00045614208600000X
NJ25MA07259500208600000X
CAA43060208600000X
AK5670208600000X
IDM-9374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H49522Medicare UPIN