Provider Demographics
NPI:1114938990
Name:KONTOS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KONTOS
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 1:16010 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1813
Mailing Address - Country:US
Mailing Address - Phone:509-928-8040
Mailing Address - Fax:509-928-0784
Practice Address - Street 1:16010 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1813
Practice Address - Country:US
Practice Address - Phone:509-928-8040
Practice Address - Fax:509-928-0784
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30698207W00000X
IDM-6605207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID180025917OtherRAILROAD MEDICARE
ID003277200Medicaid
WA0041398OtherL&I
WA1081835Medicaid
WA180015252OtherRAILROAD MEDICARE
MTP3503708Medicaid