Provider Demographics
NPI:1013919927
Name:HART, MARK ASHLEY (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ASHLEY
Last Name:HART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1209
Mailing Address - Country:US
Mailing Address - Phone:509-466-3960
Mailing Address - Fax:509-466-9566
Practice Address - Street 1:107 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1209
Practice Address - Country:US
Practice Address - Phone:509-466-3960
Practice Address - Fax:509-466-9566
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124858Medicaid
WA0200957OtherWA DEPT OF L&I
WA0229080OtherWA DEPT OF L&I
WAG98983Medicare UPIN
WA1124858Medicaid
WA0229080OtherWA DEPT OF L&I