Provider Demographics
NPI:1184659674
Name:SUN, CARRIE L (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3045
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-582-4221
Practice Address - Street 1:800 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-582-4221
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062604207R00000X
WAMD00046290207R00000X
PAMD444615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN250470OtherMEDICARE GROUP
IN000000544173OtherANTHEM PIN
IN200859330COtherMEDICAID GROUP
PA103280724Medicaid
IN200529610Medicaid
I42731Medicare UPIN