Provider Demographics
NPI:1598714248
Name:ROPKA, MARK GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GILBERT
Last Name:ROPKA
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 1:1720 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9071
Mailing Address - Country:US
Mailing Address - Phone:360-736-1195
Mailing Address - Fax:360-736-4952
Practice Address - Street 1:1720 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9071
Practice Address - Country:US
Practice Address - Phone:360-736-1195
Practice Address - Fax:360-736-4952
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0022550OtherDEPT OF LABOR & INDUSTRIE
WA1884808Medicaid
WA1884808Medicaid
WA917104Medicare ID - Type Unspecified