Provider Demographics
NPI:1346561446
Name:SHEAFOR, MARK WHITMAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WHITMAN
Last Name:SHEAFOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 WINDWARD DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-7947
Mailing Address - Country:US
Mailing Address - Phone:360-778-2252
Mailing Address - Fax:
Practice Address - Street 1:3120 SQUALICUM PKWY STE 2
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1934
Practice Address - Country:US
Practice Address - Phone:360-647-0557
Practice Address - Fax:360-733-2892
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 60134920213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6478640001Medicare NSC