Individual
MARC IRA SUFFIS
Active
Individual
MARC IRA SUFFIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00019185
WA
2083X0100X
Occupational Medicine Physician
Primary
MD00019185
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073121
—
WA
01
—
107658
LABOR & INDUSTRIES
WA
01
—
182213
LABOR & INDUSTRIES
WA
01
—
4292890
AETNA
—
01
—
8927126
CRIME VICTIMS COMP
WA
01
—
SU9526
REGENCE BLUE SHIELD
—
Enumeration date
06/22/2006
Last updated
03/07/2023
Update your record
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