Provider Demographics
NPI:1093840746
Name:STUART, SCOTT ALEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALEN
Last Name:STUART
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 SE LAKE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2193
Mailing Address - Country:US
Mailing Address - Phone:503-653-1468
Mailing Address - Fax:
Practice Address - Street 1:7831 SE LAKE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2193
Practice Address - Country:US
Practice Address - Phone:503-653-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR39575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist