Provider Demographics
NPI:1508834565
Name:NYE, SCOTT W (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:NYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:STE 7060
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-747-6194
Mailing Address - Fax:509-838-0824
Practice Address - Street 1:1414 N HOUK RD
Practice Address - Street 2:STE 104
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1097
Practice Address - Country:US
Practice Address - Phone:509-922-1376
Practice Address - Fax:509-921-9763
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00037585208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8243024Medicaid
P00206017OtherRAILROAD MEDICARE
0189201OtherDEPT OF LABOR & INDUSTRY
G93871Medicare UPIN
WA8243024Medicaid