Provider Demographics
NPI:1669401048
Name:NYREEN, MARK ROLAND (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROLAND
Last Name:NYREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:34509 9TH AVE S STE 208
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8709
Mailing Address - Country:US
Mailing Address - Phone:253-944-3278
Mailing Address - Fax:253-944-4345
Practice Address - Street 1:34509 9TH AVE S STE 208
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8709
Practice Address - Country:US
Practice Address - Phone:253-944-3278
Practice Address - Fax:253-944-4345
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA23476208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0246499OtherSTATE L&I
WA0188615OtherSTATE L&I
WA0246079OtherSTATE L&I
WA0226625OtherSTATE L&I
WAG8806019Medicare PIN
WA0246079Medicare PIN
WA0226625OtherSTATE L&I
WA0188615OtherSTATE L&I