Provider Demographics
NPI:1992898704
Name:AGNEW, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:AGNEW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3300 PROVIDENCE DR
Practice Address - Street 2:B314
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4690
Practice Address - Country:US
Practice Address - Phone:907-212-3420
Practice Address - Fax:907-212-3429
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK1145207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1009656Medicaid
AK1009656Medicaid
AKC96850Medicare UPIN