Healthcare Provider Details

I. General information

NPI: 1699875443
Provider Name (Legal Business Name): MARCUS ERIC KUYPERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S.FIRST, SUITE B
LA CONNER WA
98257-0840
US

IV. Provider business mailing address

PO BOX 850 104 S. FIRST, SUITE B
LA CONNER WA
98257-0840
US

V. Phone/Fax

Practice location:
  • Phone: 360-466-2251
  • Fax: 360-466-5673
Mailing address:
  • Phone: 360-466-2251
  • Fax: 360-466-5673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00019561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: