Provider Demographics
NPI:1790802213
Name:JACOKES, MARK WARNER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WARNER
Last Name:JACOKES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5358
Mailing Address - Fax:206-520-5620
Practice Address - Street 1:4060 E STEVENS CIR
Practice Address - Street 2:HALL HEALTH PRIMARY CARE CENTER, UNIV. OF WASHINGTON
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-685-1011
Practice Address - Fax:206-685-1853
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA60170865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA99762Medicare UPIN