MEDICARE: JASON J SUH MD

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	207R00000X	Internal Medicine Physician	MD00034987	WA
2	208M00000X	Hospitalist Physician	MD00034987	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110197712	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	126462	OTHER	WA	LABOR & IND.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8923177	OTHER	WA	CRIME VICTIMS

General Provider Information

NPI Number	:	1437150976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON J SUH MD

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-7154
Country	:	US
Telephone Number	:	360-414-2048
Fax Number	:	360-575-6749

Provider Business Practice Location Address
First Line	:	748 14TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2315
Country	:	US
Telephone Number	:	360-501-3601
Fax Number	:	360-501-3648

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/16/2011

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Directions to “ JASON J SUH MD” Practice Location

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