Provider Demographics
NPI:1194822874
Name:SCOTT, AMARYLLIS J (MD)
Entity Type:Individual
Prefix:
First Name:AMARYLLIS
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-466-6393
Mailing Address - Fax:509-466-5163
Practice Address - Street 1:785 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-466-6393
Practice Address - Fax:509-466-5163
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035266207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8209850Medicaid
WA5874430001Medicare NSC
WA8209850Medicaid
WAAB09705Medicare ID - Type Unspecified