Provider Demographics
NPI:1891846077
Name:LAYTON, MARK WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WALTER
Last Name:LAYTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1212 HARRISON AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5466
Mailing Address - Country:US
Mailing Address - Phone:360-754-6700
Mailing Address - Fax:360-754-0164
Practice Address - Street 1:1212 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5466
Practice Address - Country:US
Practice Address - Phone:360-754-6700
Practice Address - Fax:360-754-0164
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024518173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12371OtherL&I NUMBER
WA1027689Medicaid
WAA08813Medicare UPIN