Provider Demographics
NPI:1609888544
Name:SOOT, SCOTT JOHANNES (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOHANNES
Last Name:SOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 523
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-215-3550
Practice Address - Fax:503-215-3551
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD20655208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288068Medicaid
OR1629080510OtherORGANIZATION NPI
OR179218Medicare PIN
ORH24595Medicare UPIN
OR1629080510OtherORGANIZATION NPI