Provider Demographics
NPI:1205907789
Name:MARCUS E KUYPERS MD PC
Entity type:Organization
Organization Name:MARCUS E KUYPERS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:KUYPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-466-2251
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:104 S. FIRST, SUITE B
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0840
Mailing Address - Country:US
Mailing Address - Phone:360-466-2251
Mailing Address - Fax:360-466-5673
Practice Address - Street 1:104 S FIRST
Practice Address - Street 2:SUITE B
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-0840
Practice Address - Country:US
Practice Address - Phone:360-466-2251
Practice Address - Fax:360-466-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019561207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7103674Medicaid
WAGAB18208Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER