Provider Demographics
NPI:1568497303
Name:SCARBROUGH, MICHAEL DEAN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:SCARBROUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2418
Mailing Address - Country:US
Mailing Address - Phone:253-691-0649
Mailing Address - Fax:
Practice Address - Street 1:624 N YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2418
Practice Address - Country:US
Practice Address - Phone:253-691-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028701207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8129066Medicaid
SC2269OtherB/S REGENCE 90
62861OtherL&I
001054631Medicare ID - Type Unspecified
WA8129066Medicaid
050040952Medicare ID - Type UnspecifiedRR