| Doctor Name: | MARK WRAY KORMAN |
| NPI Number: | 1588007959 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 958 |
| Business Practice Address: | 107 H Street East Poplar, MT - 592550067 |
| Business Phone Number: | 4067683491 |
| Business Fax Number: | 4067685109 |
| Mailing Address: | Po Box 67, 107 H Street East POPLAR |
| State: | MT |
| Postal Code: | 592010067 |
| Phone Number: | 4067683491 |
| Fax Number: | 4067685109 |
| NPI Enumeration Date: | 04/16/2013 |
| NPI Last Update Date: | 04/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | 958 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |