MEDICARE: DR. RALPH MARC SUTHERLIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	O-264	ID
2	207Q00000X	Family Medicine Physician	O-264	ID

General Provider Information

NPI Number	:	1245291772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH MARC SUTHERLIN D.O.

Provider Business Mailing Address
First Line	:	1593 E POLSTON AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5326
Country	:	US
Telephone Number	:	208-262-2498
Fax Number	:	208-262-7461

Provider Business Practice Location Address
First Line	:	622 W COLLEGE AVE STE 2
Second Line	:
City	:	ST MARIES
State	:	ID
Zip	:	83861-1822
Country	:	US
Telephone Number	:	208-568-7800
Fax Number	:	877-902-7131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2006
Last Update Date	:	02/19/2026

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