Provider Demographics
NPI:1083621387
Name:MARKLE, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MARKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 14TH AVE
Mailing Address - Street 2:STE. 300D
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 N 14TH AVE
Practice Address - Street 2:STE. 300D
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4182
Practice Address - Country:US
Practice Address - Phone:509-545-1492
Practice Address - Fax:509-547-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0020415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000231Medicaid
WAA-07300Medicare UPIN
WA1000231Medicaid