Mark Conrad Valentine, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD00017167 Issued in WA

Practice address

3327 Colby Ave
Everett, WA 98201-6403

Phone

(425) 258-6767

Fax

(425) 259-6260

NPI assigned

Nov 30, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1043294473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3327 COLBY AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982016403",
            "telephone_number": "425-258-6767",
            "fax_number": "425-259-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3327 COLBY AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982016403",
            "telephone_number": "425-258-6767",
            "fax_number": "425-259-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALENTINE",
        "first_name": "MARK",
        "middle_name": "CONRAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD00017167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1489608",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breanna Valencia, PTA
• Emmarae S Valencia
• Christopher Salazar Valentin, MD
• Mary Elleinne Felix Valentin, NP-C
• Julie A.C. Valentine, ARNP
• Heidi Valenzuela
• Robin Valkren
• Kelly Allison Valle, AA, AAC, PEER
• Mark Vincent Vallejos
• Shelly Vallem, LMT

• Dermatology Physician in Everett, WA
• Providers in Everett, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.