Mark J Waliser, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD00025170 Issued in WA

Practice address

174 First Avenue North
Ilwaco, WA 98624-0258

Phone

(360) 642-3181

NPI assigned

Jul 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Discovery Coast Emergency Physicians LLC

  • Emergency Medicine Physician
  • Ilwaco, WA
  • NPI 1215240593
  NPD (past)
• Thurston Emergency Group a Professional LLC

  • Emergency Medicine Physician
  • Olympia, WA
  • NPI 1558526756
  NPD (past)

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356368161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX H",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240258",
            "telephone_number": "360-642-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 FIRST AVENUE NORTH",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240258",
            "telephone_number": "360-642-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALISER",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00025170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "25713",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104152",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Sutherland, RPH
• Lindy Danielle Wood Swain, PHARMD
• Gloria Vandehey, RN-CDE
• Keli Marie Vasquez, AGENCY AFFILIATED CO
• Victoria Margaret Vestal, LPTBD
• Gerald Edward Weaver, MD

• Emergency Medicine Physician in Ilwaco, WA
• Providers in Ilwaco, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.