Provider Demographics
NPI:1467574863
Name:URMANSKI, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:URMANSKI
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 1:3700 MARTIN WAY E
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5052
Mailing Address - Country:US
Mailing Address - Phone:360-923-5565
Mailing Address - Fax:360-923-5643
Practice Address - Street 1:3700 MARTIN WAY E
Practice Address - Street 2:SUITE 108
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5052
Practice Address - Country:US
Practice Address - Phone:360-923-5565
Practice Address - Fax:360-923-5643
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11450207PE0004X
WAAU11450208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA930052468OtherRRN
WA114326OtherL&I
WAUR6557OtherREGENCE
WAA08932Medicare UPIN
WA114326OtherL&I