=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205014388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT E SUCHERT DO PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2008
-----------------------------------------------------
Last Update Date | 01/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 617 5TH AVE S
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-774-5113
-----------------------------------------------------
Fax | 425-774-5114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2003
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-774-5113
-----------------------------------------------------
Fax | 425-774-5114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | ROBERT E SUCHERT
-----------------------------------------------------
Credential | DO PS
-----------------------------------------------------
Telephone | 425-774-5113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OP00000563
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------