Provider Demographics
NPI:1649414384
Name:SCALLON, AUDREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:M
Last Name:SCALLON
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 1:5107 142ND PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3446
Mailing Address - Country:US
Mailing Address - Phone:425-641-0898
Mailing Address - Fax:
Practice Address - Street 1:5107 142ND PL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3446
Practice Address - Country:US
Practice Address - Phone:425-641-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039409207Q00000X
ZZ78391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine