Individual
DR. MARC L AVERSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 864-8954
Mailing address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 864-8954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00036487
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0128730
LABOR AND INDUSTRIES
WA
01
—
080151299
MEDICARE RAIL ROAD
WA
01
—
5091691
AETNA
WA
05
—
8240954
—
WA
01
—
8934624
LABOR AND INDUSTRIES VOC
WA
01
—
AV3788
REGENCE RIDER
WA
Enumeration date
06/08/2006
Last updated
12/04/2015
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