Mark Joseph Bronk, MARK BRONK, LMP

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00015226 Issued in WA

Practice address

2615 Perth CT SE
Olympia, WA 98501-6642

Phone

(360) 561-6412

NPI assigned

Nov 15, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Mark Joseph Bronk Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1226707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341532800000",
    "number": "1295989366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 PERTH COURT SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011505",
            "telephone_number": "360-561-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 PERTH CT SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985016642",
            "telephone_number": "360-561-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONK",
        "first_name": "MARK",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "MARK BRONK, LMP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-15",
        "last_updated": "2012-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00015226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "BRONK",
            "middle_name": "JOSEPH",
            "prefix": "MR.",
            "credential": "MARL BRONK, LMP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Specialist in Olympia, WA
• Providers in Olympia, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; 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.