Provider Demographics
NPI:1710081351
Name:MOHR, SCOT K (PHYSICIAN ASSISTNAT)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:K
Last Name:MOHR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTNAT
Other - Prefix:
Other - First Name:K
Other - Middle Name:SCOT
Other - Last Name:MOHR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:BLDG R3722, STRYKER AVE.
Mailing Address - Street 2:4TH BN, 160TH SOAR, AID STATION, MAIL STOP 23B
Mailing Address - City:FORT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433
Mailing Address - Country:US
Mailing Address - Phone:253-966-6791
Mailing Address - Fax:
Practice Address - Street 1:BLDG R3722, STRYKER AVE.
Practice Address - Street 2:4TH BN, 160TH SOAR, AID STATION, MAIL STOP 23B
Practice Address - City:FORT LEWIS
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-966-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant