Provider Demographics
NPI:1598970675
Name:SCOTT, PAUL MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 S YAKIMA AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5300
Mailing Address - Country:US
Mailing Address - Phone:253-627-9151
Mailing Address - Fax:253-591-8892
Practice Address - Street 1:1708 S YAKIMA AVE
Practice Address - Street 2:STE 110
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5300
Practice Address - Country:US
Practice Address - Phone:253-627-9151
Practice Address - Fax:253-591-8892
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000816213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223172OtherSTATE L&I
WA0224379OtherSTATE L&I
WA0237067OtherSTATE L&I
WA8945569OtherSTATE CRIME VICTIMS
WAP00447141OtherRAILROAD
WA0222100OtherSTATE L&I
WA8485849Medicaid
WA0224379OtherSTATE L&I
WA8945569OtherSTATE CRIME VICTIMS
WAG8866443Medicare PIN
WAG8875344Medicare PIN