DR. MARK S PECKLER (NPI# 1770511438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770511438 |
| Entity Type | Individual |
| Full Name | DR. MARK S PECKLER |
| Credential | M.D. |
| Practice Address |
3525 Ensign Rd. Suite A Olympia WA 98505-0001 |
| Mailing Address |
3525 Ensign Rd Ne Suite A Olympia WA 98506-5065 |
| Practice Telephone | 3604564666 |
| Practice Fax Number | 3604591566 |
| Mailing Telephone | 3604564666 |
| Mailing Fax Number | 3604591566 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2015-01-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD00019049 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1789601 | 05 | |
| WA | REGENCE | T00100 | 01 |
| WA | PTAN | G001048501 | 01 |
| WA | LABOR AND INDUSTRIES | 17815 | 01 |
| Street Address |
3525 ENSIGN RD. SUITE A |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98505-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841590502 | Barbara Ann Krulich | Physician Assistant | 2700 Evergreen Parkway Nw, Seminar I 2100, Olympia, WA 98505 | 2010-10-28 |
| 1447568563 | Polly Kay Taylor | Nurse Practitioner | 2700 Evergreen Parkway Nw, Sem 1, Room 2110, The Evergreen Sate College Student Health Center, Olympia, WA 98505 | 2010-09-23 |
| 1811370307 | Jared Vedros | Emergency Medicine | 786 D St, Anchorage, AK 98505 | 2015-07-02 |
| 1740246602 | Janine R Morrell | Nurse Practitioner | 315 Mlk Jr Way, Ms Z0 Ntl, Tacoma, WA 98505 | 2006-04-20 |
| 1609494830 | Madison Samantha Johnson | Counselor | The Evergreen State College 2700 Evergreen Parkway Nw, Olympia, WA 98505-0001 | 2020-07-14 |
| 1710504972 | Ryan Erickson | Counselor | 2700 Evergreen Pkwy Nw Bldg I2731, Olympia, WA 98505-0001 | 2020-07-02 |
| 1619285368 | Elizabeth R Mchugh | Physician Assistant | The Evergreen State College, Seminar 1 Rm 2110, Olympia, WA 98505-0001 | 2010-09-15 |
| 1770600629 | Rebecca Rae Johnson | Specialist/Technologist | 2700 Evergreen Pkwy Nw, Olympia, WA 98505-0001 | 2007-03-24 |
| 1104134923 | Susan Estelle Camp | Registered Nurse | 2700 Evergreen Pkwy Nw, Seminar 1-2110, Olympia, WA 98505-0001 | 2010-09-14 |
| 1144499682 | Kathleen Ann O'connor | Preventive Medicine | 2700 Evergreen Pkwy Nw, Sem I, 2110, Olympia, WA 98505-0005 | 2008-02-28 |
| Find all providers in zip 98505 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548359417 | David Wayne Marsh | Urology | 412 Black Hills Ln Sw Ste C, Olympia, WA 98502-8142 | 2006-10-11 |
| 1972602969 | Edith Diane Wilson | Urology | 615 Lilly Rd Ne Ste 175, Olympia, WA 98506-5179 | 2006-09-22 |
| 1174637599 | Michael R Ellen Md Ps | Urology | 128 Lilly Rd Ne, Suite 205, Olympia, WA 98506-5029 | 2006-08-19 |
| 1679590384 | John H Farrer Md | Urology | 703 Lilly Road Ne, Suite 104, Olympia, WA 98506 | 2006-07-17 |
| 1104801356 | John Kelley Muenchrath | Urology | 404 Yauger Way Sw Ste 100, Olympia, WA 98502-8152 | 2005-12-09 |
| 1043203771 | Daniel Mark Brown | Urology | 402 Black Hills Ln Sw, Suite A, Olympia, WA 98502-8145 | 2005-08-29 |
| 1548606346 | Patrick William Murray | Urology | 149 Lilly Rd Ne, Olympia, WA 98506 | 2013-05-20 |
| 1861752347 | Wai Lee | Urology | 149 Lilly Rd Ne, Olympia, WA 98506-5028 | 2012-05-18 |
| 1760785281 | Capital Medical Center Specialty Physicians, LLC | Urology | 3900 Capitol Mall Dr Sw, Olympia, WA 98502-8654 | 2010-12-07 |
| 1386946325 | Capital Urology | Urology | 404 Black Hills Ln Sw Ste D, Olympia, WA 98502-8148 | 2010-11-24 |
| Find all providers in OLYMPIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.