Provider Demographics
NPI:1801832050
Name:SUFFIS, MARC IRA (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:IRA
Last Name:SUFFIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 NW ANDERSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6807
Mailing Address - Country:US
Mailing Address - Phone:360-698-6630
Mailing Address - Fax:
Practice Address - Street 1:4409 NW ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6807
Practice Address - Country:US
Practice Address - Phone:360-698-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019185207P00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8927126OtherCRIME VICTIMS COMP
4292890OtherAETNA
SU9526OtherREGENCE BLUE SHIELD
WA107658OtherLABOR & INDUSTRIES
WA1073121Medicaid
WA182213OtherLABOR & INDUSTRIES
WA182213OtherLABOR & INDUSTRIES
WAG8867358Medicare PIN
WAG000250462Medicare PIN
WAGAB05186Medicare PIN
WAG000250654Medicare PIN
AS9466865OtherDEA
WA182213OtherLABOR & INDUSTRIES
A06516Medicare UPIN
WAG8852227Medicare PIN
WA1073121Medicaid