Provider Demographics
NPI:1235798067
Name:WALSWORTH, MARK CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTIAN
Last Name:WALSWORTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1919 LINCOLN WAY STE 315
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2527
Mailing Address - Country:US
Mailing Address - Phone:208-625-6000
Mailing Address - Fax:
Practice Address - Street 1:920 W IRONWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2464
Practice Address - Country:US
Practice Address - Phone:208-667-4557
Practice Address - Fax:208-765-2887
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM16095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine